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A nationwide database analysis of demographics and outcomes related to Extracorporeal Membrane Oxygenation (ECMO) in congenital diaphragmatic hernia

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Abstract

Purpose

The aim of the study was to understand the use of Extracorporeal Membrane Oxygenation (ECMO) in congenital diaphragmatic hernia (CDH) and its outcomes.

Methods

The 2016 Kid’s Inpatient Database (KID) obtained from the national Healthcare Cost and Utilization Project (HCUP) was used to obtain CDH birth, demographic, and outcome data associated with ECMO use. Categorical variables were analyzed and odds ratios (OR) with 95% confidence intervals (CI) are reported for variables found to have significance (p < 0.05). Appropriate regressions were used for comparing categorical and continuous data using SPSS 25 for Macintosh.

Results

The database contained 1189 cases of CDH, of which 133 (11.2%) received ECMO. The overall mortality of neonates with CDH was 18.9% (225/1189). Newborns with CDH on ECMO had a survival of 46% (61/133) compared to 85.5% without ECMO (903/1056) (OR 6.966, p < 0.001, 95% CI 4.756–10.204). ECMO increased length of stay from 24.6 to 69.8 days (OR 2.834, p < 0.001, 95% CI 2.768–2.903) and average cost from $375,002.20 to $1641,586.83 (OR 4.378, p < 0.001, 95% CI 3.341–5.735).

Conclusions

Increased length of stay, costs, and outcomes with ECMO use in CDH should prompt an examination of criteria necessitating ECMO.

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Abbreviations

CDH:

Congenital diaphragmatic hernia

ECMO:

Extracorporeal Membrane Oxygenation

HCUP:

Healthcare Cost and Utilization Project

KID:

Kid’s Inpatient Database

OR:

Odds ratio

CI:

Confidence interval

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA

    Alana N. Snyder & Tiffany Cheng

  2. Division Chief of Adolescent Obesity Surgery, RWJ Medical School, Rutgers, State University of New Jersey, 504 MEB, 1 RWJ Place, New Brunswick, NJ, 08901, USA

    Sathyaprasad Burjonrappa

Authors
  1. Alana N. Snyder
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  2. Tiffany Cheng
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  3. Sathyaprasad Burjonrappa
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Corresponding author

Correspondence to Sathyaprasad Burjonrappa.

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Appendix A

Appendix A

The following lists the categorical variables that were grouped differently than the HCUP groupings. Groups were only combined. Grouping was changed only when criteria for Pearson’s Chi-squared test was not met due to a cell size < 5.

A.1.1 Primary expected payer

The HCUP categorization of this variable an indicator of expected primary payer:

  1. (1)

    Medicare,

  2. (2)

    Medicaid,

  3. (3)

    Private including HMO,

  4. (4)

    Self-pay,

  5. (5)

    No charge,

  6. (6)

    Other.

This variable was regrouped as:

  1. (1)

    Medicare, Medicaid, or no charge or

  2. (2)

    Private, HMO, Self-pay, other.

A.1.2 Race

The HCUP categorization of this variable an indicator of race:

  1. (1)

    White,

  2. (2)

    Black,

  3. (3)

    Hispanic,

  4. (4)

    Asian or Pacific Islander,

  5. (5)

    Native American,

  6. (6)

    Other.

This variable was regrouped as:

  1. (1)

    White

  2. (2)

    Black

  3. (3)

    Hispanic

  4. (4)

    Other.

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Snyder, A.N., Cheng, T. & Burjonrappa, S. A nationwide database analysis of demographics and outcomes related to Extracorporeal Membrane Oxygenation (ECMO) in congenital diaphragmatic hernia. Pediatr Surg Int 37, 1505–1513 (2021). https://doi.org/10.1007/s00383-021-04979-y

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  • DOI: https://doi.org/10.1007/s00383-021-04979-y

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