The association of type of surgical closure on length of stay among infants with gastroschisis born≥34 weeks' gestation

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

doi:10.1016/j.jpedsurg.2013.12.020

The association of type of surgical closure on length of stay among infants with gastroschisis born≥34 weeks' gestation

J Pediatr Surg. 2014 Aug;49(8):1220-5. doi: 10.1016/j.jpedsurg.2013.12.020. Epub 2014 Jan 2.

Authors

Karna Murthy¹, Jacquelyn R Evans², Amina M Bhatia³, David H Rothstein⁴, Rajan Wadhawan⁵, Isabella Zaniletti⁶, Rakesh Rao⁷, Cary Thurm⁶, Amit M Mathur⁷, Anthony J Piazza⁸, James E Stein⁹, Kristina M Reber¹⁰, Billie Lou Short¹¹, Michael A Padula², David J Durand¹², Jeanette M Asselin¹³, Eugenia K Pallotto¹⁴, Francine D Dykes⁸

Affiliations

¹ Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address: k-murthy@northwestern.edu.
² Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ Children's Healthcare of Atlanta at Egleston, Egleston, GA, USA; Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
⁴ Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁵ Florida Hospital for Children, Center for Neonatal Care, Orlando, FL, USA; Department of Pediatrics, University of Central Florida School of Medicine, Orlando, FL, USA.
⁶ Children's Hospital Association, Overland Park, KS, USA.
⁷ Washington University School of Medicine in St. Louis, St. Louis, MO, USA; St. Louis Children's Hospital, Department of Pediatrics, St Louis, MO, USA.
⁸ Children's Healthcare of Atlanta at Egleston, Egleston, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
⁹ Children's Hospital Los Angeles, Department of Surgery, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁰ Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, USA.
¹¹ Children's National Health System, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
¹² Children's Hospital Research Center, Oakland, CA, USA.
¹³ Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA.
¹⁴ Children's Mercy, Kansas City, MO, USA; Department of Pediatrics, University of Missouri School of Medicine, Kansas City, MO, USA.

PMID: 25092080
DOI: 10.1016/j.jpedsurg.2013.12.020

Abstract

Background/purpose: The 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/methods: We 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.

Results: Among 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.

Conclusions: In 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: Children's Hospitals Neonatal Consortium; Children’s Hospital Neonatal Database (CHND); Gastroschisis; Infant; Length of stay; Neonatal intensive care; Staged closure.

Publication types

Multicenter Study

MeSH terms

Abdominal Wall / surgery*
Female
Follow-Up Studies
Gastroschisis / surgery*
Gestational Age
Humans
Infant
Infant, Low Birth Weight*
Infant, Newborn
Infant, Premature, Diseases / surgery*
Intensive Care Units, Neonatal
Length of Stay / trends
Male
Retrospective Studies
Surgical Procedures, Operative / methods*
Time Factors
Treatment Outcome
Wound Healing*