Variability in outcomes after gastroschisis closure across U.S. children's hospitals.

Document Type

Article

Publication Date

3-1-2018

Identifier

DOI: 10.1016/j.jpedsurg.2017.04.012

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

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.

Journal Title

Journal of pediatric surgery

Volume

53

Issue

3

First Page

513

Last Page

520

MeSH Keywords

Birth Weight; Child; Child, Preschool; Female; Gastroschisis; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Length of Stay; Male; Parenteral Nutrition, Total; Retrospective Studies; Time Factors; Treatment Outcome; United States

Keywords

Delayed closure; Early closure; Gastroschisis; Outcomes; Pediatric surgery; Variability

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