Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia

Objective:to estimate the presence and sources of inter-center variation (icv) in the risk of death or tracheostomy placement (d/t) among infants with severe bronchopulmonary dysplasia (sbpd)study design:we analyzed the children's hospitals neonatal database between 2010 and 2013 to identify referred infants born <32 weeks' gestation with sbpd. the association between center and the primary outcome of d/t was analyzed by multivariable modeling. hypothesized diagnoses/practices were included to determine if these explained any observed icv in d/t.results:d/t occurred in 280 (20%) of 1383 eligible infants from 21 centers. icv was significant for d/t (range 2–46% by center, p<0.001) and tracheostomy placement (n=187, range 2–37%, p<0.001), but not death (n=93, range 0–19%, p=0.08). this association persisted in multivariable analysis (adjusted center-specific odds ratios for d/t varied 5.5-fold, p=0.009).conclusions:icv in d/t is apparent among infants with sbpd. these results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.