Impact of Centralization of Care for Patients With Congenital Diaphragmatic Hernia in Sweden

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-04-03 DOI:10.1016/j.jpedsurg.2025.162314

Carmen Mesas Burgos , Vladimir Gatzinsky , Petra Nord , Elisabet Gustafson , Pernilla Stenström , Hans Winberg , Manja Nilsson , Lars Mikael Broman , Evelina Rosén , Tomas Wester

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引用次数: 0

Abstract

Aim

There is very limited data regarding the impact of centralization of care of patients with congenital diaphragmatic hernia (CDH). The National Board of Health and Welfare in Sweden decided to centralize the care of CDH from July 2018.

The aim of this study was to assess the short-term impact of centralization in patient outcomes.

Methods

This was a retrospective observational study including all centers in Sweden managing CDH before and after centralization. Outcomes for patients born with CDH who were managed from 1st of July 2013 to 30th of June 2018 (before centralization) were compared with patients managed 1st of July 2018 to 30th of June 2023 (after centralization). Fisher’s exact test and non-parametric tests were used to compare differences between the two time periods and a p < 0.05 was considered statistically significant. The study was approved by the Swedish Ethical Review Authority (2023-02650-01).

Main results

A total of 243 patients with CDH were managed nationally during the study period, 111 before and 132 after centralization. The rates of prenatal diagnosis, side of the defect, need of patch, or mortality did not differ significantly between the study periods. The need for ECMO decreased significantly after centralization 18 % vs. 7 %, p < 0.01).

Conclusions

After centralization, we observed a decreased rate of need for ECMO support. Although the time from centralization push through is short, it underscores the importance of an ongoing evaluation, optimization and strategic planning in order to find, describe and maximize the possible benefits of a centralization of CDH in our settings.

Type of Study

Retrospective cohort study, nationwide.

Level of Evidence

II.

查看原文本刊更多论文

瑞典先天性膈疝患者集中护理的影响。

目的：关于先天性膈疝（CDH）患者集中护理的影响的数据非常有限。瑞典国家卫生和福利委员会决定从2018年7月起集中治疗CDH。本研究的目的是评估集中治疗对患者预后的短期影响。方法：这是一项回顾性观察性研究，包括瑞典所有中心化前后管理CDH的中心。将2013年7月1日至2018年6月30日（集中化前）治疗的先天性CDH患者的结果与2018年7月1日至2023年6月30日（集中化后）治疗的患者的结果进行比较。使用Fisher精确检验和非参数检验来比较两个时间段和一个时间段的差异。结论：集中化后，我们观察到ECMO支持的需求率下降。虽然从集中化推进的时间很短，但它强调了持续评估、优化和战略规划的重要性，以便发现、描述和最大限度地发挥CDH集中化在我们环境中的可能好处。研究类型：回顾性队列研究，全国性证据等级：II。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.