gms | German Medical Science

20. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

21. - 23.03.2019, Berlin

Relationship between volume and outcome for congenital diaphragmatic hernia: a systematic review

Meeting Abstract

  • Johannes Morche - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Deutschland; Gemeinsamer Bundesausschuss, Fachberatung Medizin, Deutschland
  • Tim Mathes - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Deutschland
  • Anja Jacobs - Gemeinsamer Bundesausschuss, Fachberatung Medizin, Deutschland
  • Barbara Pietsch - Gemeinsamer Bundesausschuss, Fachberatung Medizin, Deutschland
  • Lucas Wessel - Medizinische Fakultät Mannheim, Universität Heidelberg, Kinderchirurgische Klinik, Mannheim, Deutschland
  • Sabine Gruber - Gemeinsamer Bundesausschuss, Fachberatung Medizin, Deutschland
  • Edmund AM Neugebauer - Medizinische Hochschule Brandenburg Theodor Fontane, Deutschland
  • Dawid Pieper - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Deutschland

EbM und Digitale Transformation in der Medizin. 20. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Berlin, 21.-23.03.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. Doc19ebmP-OG09-06

doi: 10.3205/19ebm120, urn:nbn:de:0183-19ebm1201

Published: March 20, 2019

© 2019 Morche et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background/research question: Congenital diaphragmatic hernia is a rare and life-threatening anomaly that occurs during fetal development and results in an incomplete or incorrect formation of the diaphragm. Surgical therapy of the diaphragm should be performed after clinical stabilization of the neonate. Higher hospital or surgeon volume has previously been found to be associated with better clinical outcomes for different especially high-risk, low volume procedures. Therefore, we aim to examine the relationship between hospital or surgeon volume and outcomes for congenital diaphragmatic hernia.

Methods: We will perform a systematic literature search in Medline, Embase, CINAHL, and Biosis Previews without applying any limitations. In addition, we will search for relevant conference abstracts. We will screen titles and abstracts of retrieved studies, obtain potentially relevant full texts and assess the eligibility of those full texts against our inclusion criteria. We will include comparative studies analyzing the relationship between hospital or surgeon volume and clinical outcomes. We will systematically assess risk of bias of included studies using ROBINS (Risk Of Bias In Non-randomized Studies) and extract data on the study design, patient characteristics, case-mix adjustments, statistical methods, hospital and surgeon volume as well as outcomes into standardized tables. Title and abstract screening, full text screening, critical appraisal and data extraction of results will be conducted by two reviewers independently. Other data will be extracted by one reviewer and checked for accuracy by a second one. Any disagreements will be resolved by discussion. We will not perform a meta-analysis as we expect included studies to be clinically and methodologically very diverse. We will synthesize findings from primary studies in a structured narrative way and using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Preliminary or expected results, outlook: Given the lack of a comprehensive summary of findings on the relationship between hospital or surgeon volume and outcomes for congenital diaphragmatic hernia, this systematic review will put things right. Results can be used to inform decision makers or clinicians and to adapt medical care. Additionally, findings on the usage of ROBINS for risk of bias assessment and GRADE for synthesis of results might lead to methodological insights.

Note: Systematic review registration: PROSPERO CRD42018090231

Competing interests: LW received remuneration as a member of the scientific advisory board from Shire and remuneration for lecturing from Chiesi (both not related to the conduct of the systematic review). All other authors declare to have no competing interests.