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The association of type of surgical closure on length of stay among infants with gastroschisis born ≥ 34 weeks’ gestation |
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| Authors: | Karna Murthy Jacquelyn R Evans Amina M Bhatia David H Rothstein Rajan Wadhawan Isabella Zaniletti Rakesh Rao Cary Thurm Amit M Mathur Anthony J Piazza James E Stein Kristina M Reber Billie Lou Short Michael A Padula David J Durand Jeanette M Asselin Eugenia K Pallotto Francine D Dykes |
| Institution: | 1. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA;2. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;3. Children’s Hospital of Philadelphia, Philadelphia, PA, USA;4. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;5. Children’s Healthcare of Atlanta at Egleston, Egleston, GA, USA;6. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA;g Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;h Florida Hospital for Children, Center for Neonatal Care, Orlando, FL, USA;i Department of Pediatrics, University of Central Florida School of Medicine, Orlando, FL, USA;j Children’s Hospital Association, Overland Park, KS, USA;k Washington University School of Medicine in St. Louis, St. Louis, MO, USA;l St. Louis Children’s Hospital, Department of Pediatrics, St Louis, MO, USA;m Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA;n Children’s Hospital Los Angeles, Department of Surgery, Los Angeles, CA, USA;o Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;p Nationwide Children’s Hospital, Columbus, OH, USA;q The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, USA;r Children’s National Health System, Washington, DC, USA;s Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA;t Children’s Hospital Research Center, Oakland, CA, USA;u Children’s Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA;v Children’s Mercy, Kansas City, MO, USA;w Department of Pediatrics, University of Missouri School of Medicine, Kansas City, MO, USA |
| Abstract: | Background/PurposeThe optimal surgical approach in infants with gastroschisis (GS) is unknown. The purpose of this study was to estimate the association between staged closure and length of stay (LOS) in infants with GS.Design/MethodsWe used the Children's Hospital Neonatal Database to identify surviving infants with GS born ≥ 34 weeks' gestation referred to participating NICUs. Infants with complex GS, bowel atresia, or referred after 2 days of age were excluded. The primary outcome was LOS; multivariable linear regression was used to quantify the relationship between staged closure and LOS.ResultsAmong 442 eligible infants, staged closure occurred in 68.1% and was associated with an increased median LOS relative to odds ration (OR):primary closure (37 vs. 28 days, p < 0.001). This association persisted in the multivariable equation (β = 1.35, 95% CI: 1.21, 1.52, p < 0.001) after adjusting for the presence of necrotizing enterocolitis, short bowel syndrome, and central-line associated bloodstream infections.ConclusionsIn this large, multicenter cohort of infants with GS, staged closure was independently associated with increased LOS. These data can be used to enhance antenatal and pre-operative counseling and also suggest that some infants who receive staged closure may benefit from primary repair. |
| Keywords: | Infant Gastroschisis Staged closure Neonatal intensive care Length of stay Children&rsquo s Hospital Neonatal Database (CHND) Children's Hospitals Neonatal Consortium |
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