J Pediatr Surg
. 2025 Apr 3;60(6):162314.
doi: 10.1016/j.jpedsurg.2025.162314. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/40187553/
Impact of Centralization of Care for Patients With Congenital Diaphragmatic Hernia in Sweden
Carmen Mesas Burgos 1, Vladimir Gatzinsky 2, Petra Nord 3, Elisabet Gustafson 4, Pernilla Stenström 5, Hans Winberg 5, Manja Nilsson 6, Lars Mikael Broman 7, Evelina Rosén 8, Tomas Wester 3
Affiliations Expand
- PMID: 40187553
- DOI: 10.1016/j.jpedsurg.2025.162314
Free article
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.
Keywords: Centralization; Congenital diaphragmatic hernia (CDH); Extracorporeal membrane oxygenation (ECMO); Pediatric surgery; Rare diseases.
Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.
