Dani O Gonzalez1, Jennifer N Cooper2, Shawn D St Peter3, Peter C Minneci4, Katherine J Deans5. 1. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205; Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029. Electronic address: Dani.Gonzalez@nationwidechildrens.org. 2. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205. Electronic address: Jennifer.Cooper@nationwidechildrens.org. 3. Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64155. Electronic address: SSPeter@cmh.edu. 4. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205. Electronic address: Peter.Minneci@nationwidechildrens.org. 5. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205. Electronic address: Katherine.deans@nationwidechildrens.org.
Abstract
BACKGROUND: In patients undergoing gastroschisis closure, the effects of timing of closure and patient and hospital-level characteristics on length of stay (LOS) and time to enteral autonomy are unknown. STUDY DESIGN: Using the Pediatric Health Information System, we compared neonates who underwent early (within 1day of birth) versus delayed (>1day after birth) gastroschisis closure from 2005 to 2013. We evaluated the relationship between time to closure and both LOS and days on total parenteral nutrition (TPN). RESULTS: Of 4459 neonates with gastroschisis, 43.9% underwent early closure and 56.1% underwent delayed closure. Delayed closure, complicated gastroschisis, government insurance, lower birth weight, older age at closure, and complex chronic conditions were associated with longer LOS and days on TPN (all p<0.05). There was significant inter-hospital variability in both outcomes, after adjusting for patient- and hospital-level characteristics, including hospitals' gastroschisis and neonatal volumes, median age at closure, and percentages of complicated and delayed gastroschisis patients, (p<0.01). CONCLUSION: Delayed gastroschisis closure is associated with longer LOS and duration of TPN, even after excluding complicated cases. Furthermore, after controlling for hospital volume, rate of complicated gastroschisis, and timing of closure, the persistent inter-hospital variability suggests that practice variability is partially responsible for these differences. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: III.
BACKGROUND: In patients undergoing gastroschisis closure, the effects of timing of closure and patient and hospital-level characteristics on length of stay (LOS) and time to enteral autonomy are unknown. STUDY DESIGN: Using the Pediatric Health Information System, we compared neonates who underwent early (within 1day of birth) versus delayed (>1day after birth) gastroschisis closure from 2005 to 2013. We evaluated the relationship between time to closure and both LOS and days on total parenteral nutrition (TPN). RESULTS: Of 4459 neonates with gastroschisis, 43.9% underwent early closure and 56.1% underwent delayed closure. Delayed closure, complicated gastroschisis, government insurance, lower birth weight, older age at closure, and complex chronic conditions were associated with longer LOS and days on TPN (all p<0.05). There was significant inter-hospital variability in both outcomes, after adjusting for patient- and hospital-level characteristics, including hospitals' gastroschisis and neonatal volumes, median age at closure, and percentages of complicated and delayed gastroschisis patients, (p<0.01). CONCLUSION: Delayed gastroschisis closure is associated with longer LOS and duration of TPN, even after excluding complicated cases. Furthermore, after controlling for hospital volume, rate of complicated gastroschisis, and timing of closure, the persistent inter-hospital variability suggests that practice variability is partially responsible for these differences. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: III.
Authors: Melissa Wong; Assaf P Oron; Anna Faino; Susan Stanford; Jennifer Stevens; Claudia S Crowell; Patrick J Javid Journal: Am J Surg Date: 2020-03-09 Impact factor: 2.565
Authors: Asta Tauriainen; Anna Hyvärinen; Arimatias Raitio; Ulla Sankilampi; Mikko Gärding; Tuomas Tauriainen; Ilkka Helenius; Kari Vanamo Journal: Pediatr Surg Int Date: 2021-09-05 Impact factor: 1.827
Authors: Andrea Schmedding; Boris Wittekind; Emilia Salzmann-Manrique; Rolf Schloesser; Udo Rolle Journal: Pediatr Surg Int Date: 2020-03-26 Impact factor: 1.827