Variation in rates of severe retinopathy of prematurity among neonatal intensive care units in the Australian and New Zealand Neonatal Network

Aim: To analyse variations in rates of severe retinopathy of prematurity (ROP) among neonatal intensive care units (NICUs) in the Australian and New Zealand Neonatal Network (ANZNN), adjusting for sampling variability and for case mix. Methods: 25 NICUs were included in the study of 2105 infants born at less than 29 weeks in 1998 and 1999, who survived to 36 weeks post-menstrual age and were examined for ROP. The observed NICU rates of severe ROP were adjusted for case mix using logistic regression on gestation, weight for gestational age and sex, and for sampling variability using shrinkage estimates. The corrected rate in the best 20% of NICUs was identified and NICU variations in rates were compared with those in 2000-1. Results: The overall (unadjusted) rate of severe ROP in the NICUs was 9.6% (interquartile range 5.4-12.8%). After adjusting for both case mix and sampling variability there remained significant variation among the NICUs. 20% of NICUs had a rate of severe ROP <= 5.9%. Variation in rates among NICUs showed a similar pattern in both time periods. If the overall network rate was reduced to 5.9%, the 20th centile of the adjusted rates, there would be 79 fewer cases in a 2 year period, in contrast with 26 fewer if rates in the two units with excess rates improved to the average. Conclusions: Considerable variation in rates of severe ROP among NICUs remained after adjustment for case mix and sampling variability. These data will facilitate investigation of potentially better practices associated with a reduced risk of severe ROP.