Risk factors for perioperative hypothermia and infectious outcomes in gastroschisis patients |
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| Authors: | Christina M Bence Rachel M Landisch Ruizhe Wu Aniko Szabo Kathryn McElhinney Mary T Austin Jason D Fraser Shawn D St Peter Shilvi Joshi Joseph B Lillegard Shirli Tay Brad W Warner Aimee G Kim Erin E Perrone Charles M Leys Jonathan E Kohler Amy J Wagner |
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| Institution: | 1. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, United States;2. Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States;3. Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States;4. Division of Pediatric Surgery, Department of Surgery, Children''s Mercy Hospital, Kansas City, MO, United States;5. Department of Pediatric Surgery, Children''s Minnesota, Minneapolis, MN, United States;6. Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States;7. Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States;8. Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States |
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| Abstract: | IntroductionPrior data suggest that infants with gastroschisis are at high risk for hypothermia and infectious complications (ICs). This study evaluated the associations between perioperative hypothermia (PH) and ICs in gastroschisis using a multi-institutional cohort.MethodsRetrospective review of infants with gastroschisis who underwent abdominal closure from 2013–2017 was performed at 7 children's hospitals. Any-IC and surgical site infection (SSI) were stratified against the presence or absence of PH, and perioperative characteristics associated with PH and SSI were determined using multivariable logistic regression.ResultsOf 256 gastroschisis neonates, 42% developed PH, with 18% classified as mild hypothermia (35.5–35.9°C), 10.5% as moderate (35.0–35.4°C), and 13% severe (<35°C). There were 82 (32%) ICs with 50 (19.5%) being SSIs. No associations between PH and any-IC (p = 0.7) or SSI (p = 0.98) were found. Pulmonary comorbidities (odds ratio (OR)=3.76, 95%CI:1.42–10, p = 0.008) and primary closure (OR=0.21, 95%CI:0.12–0.39, p<0.001) were associated with PH, while silo placement (OR=2.62, 95%CI:1.1–6.3, p = 0.03) and prosthetic patch (OR=3.42, 95%CI:1.4–8.3, p = 0.007) were associated with SSI on multivariable logistic regression.ConclusionsPrimary abdominal closure and pulmonary comorbidities are associated with PH in gastroschisis, however PH was not associated with increased risk of ICs. Independent risk factors for SSI include silo placement and prosthetic patch closure. |
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