Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network

J Pediatr Surg. 2011 May;46(5):801-7. doi: 10.1016/j.jpedsurg.2011.02.008.


Background: Perinatal management of congenital diaphragmatic hernia (CDH) and gastroschisis (GS) remains nonstandardized and institution specific. This analysis describes practice and outcome variation across a national network.

Methods: A national, prospective, disease-specific database for CDH and GS was evaluated over 4 years. Centers were evaluated individually and defined as low (low-volume center [LVC]) or high (high-volume center [HVC]) volume based on case mean.

Results: Congenital diaphragmatic hernia. Two hundred fifteen liveborn cases were studied (mean, 14.3 cases/center) across 15 centers (8 LVCs and 7 HVCs). Significant interinstitutional practice variation was noted in rates of termination (0%-40%) and cesarean delivery (0%-61%). Centers demonstrated marked variation in ventilation strategies, vasodilator and paralytic use, timing of surgery, and rates of primary closure. Overall survival was 81.4% (LVC, 76.9%; HVC, 82.4%; P = .43). Gastroschisis. Four hundred sixteen cases were investigated (mean, 26 cases/center; range, 6-72) across 16 centers (10 LVCs and 6 HVCs). Cesarean delivery rates varied widely between centers (0%-86%) as did timing of closure (early vs delayed, 1%-100%). There was no difference in length of stay, days on total parenteral nutrition, and overall survival (94.3% vs 97.2%; P = .17) between LVCs and HVCs.

Conclusions: The existence of perinatal practice and outcome variation for GS and CDH suggests targets for improved delivery of care and justifies efforts to standardize treatment on a national basis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Eugenic / statistics & numerical data
  • Canada / epidemiology
  • Cesarean Section / statistics & numerical data
  • Combined Modality Therapy
  • Databases, Factual*
  • Disease Management
  • Drug Utilization / statistics & numerical data
  • Gastroschisis / embryology
  • Gastroschisis / mortality
  • Gastroschisis / surgery*
  • General Surgery / organization & administration
  • Hernia, Diaphragmatic / embryology
  • Hernia, Diaphragmatic / mortality
  • Hernia, Diaphragmatic / surgery
  • Hernias, Diaphragmatic, Congenital*
  • Humans
  • Infant, Newborn
  • Institutional Practice / standards
  • Institutional Practice / statistics & numerical data*
  • Neuromuscular Agents / therapeutic use
  • Pediatrics / organization & administration
  • Prenatal Diagnosis
  • Prospective Studies
  • Respiration, Artificial / methods
  • Respiration, Artificial / statistics & numerical data
  • Societies, Medical
  • Survival Rate
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use


  • Neuromuscular Agents
  • Vasodilator Agents