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J Pediatr Surg. 2014 Dec;49(12):1771-5. doi: 10.1016/j.jpedsurg.2014.09.019. Epub 2014 Nov 8.

Improving gastroschisis outcomes: does birth place matter?

Author information

1
University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: ksavoie@uthsc.edu.
2
University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: ehuang@uthsc.edu.
3
University of Texas at Houston, Houston, Texas. Electronic address: shahroz.k.aziz@uth.tmc.edu.
4
Vanderbilt University, Nashville, Tennessee. Electronic address: martin.blakely@vanderbilt.edu.
5
University of Arkansas, Little Rock, Arkansas. Electronic address: dassingermelvins@uams.edu.
6
Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: adorale@iupui.edu.
7
Vanderbilt University, Nashville, Tennessee. Electronic address: eileen.m.duggan@vanderbilt.edu.
8
University of Texas at Houston, Houston, Texas. Electronic address: matthew.t.harting@uth.tmc.edu.
9
Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: tmarkel@iupui.edu.
10
University of Texas at Houston, Houston, Texas. Electronic address: stacey.d.moore-olufemi@uth.tmc.edu.
11
University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: sshah@cmh.edu.
12
University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: sspeter@cmh.edu.
13
University of Texas at Houston, Houston, Texas. Electronic address: koujen.tsao@uth.tmc.edu.
14
University of Arkansas, Little Rock, Arkansas. Electronic address: dlwyrick@uams.edu.
15
University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: rfwillia@uthsc.edu.

Abstract

PURPOSE:

Babies born in the hospital where they obtain definitive surgical care do not require transportation between institutions and may have shorter time to surgical intervention. Whether these differences result in meaningful improvement in outcomes has been debated. A multi-institutional retrospective study was performed comparing outcomes based on birthplace.

METHODS:

Six institutions within the PedSRC reviewed infants born with gastroschisis from 2008 to 2013. Birthplace, perinatal, and postoperative data were collected. Based on the P-NSQIP definition, inborn was defined as birth at the pediatric hospital where repair occurred. The primary outcome was days to full enteral nutrition (FEN; 120kcal/kg/day).

RESULTS:

528 patients with gastroschisis were identified: 286 inborn, 242 outborn. Days to FEN, time to bowel coverage and abdominal wall closure, primary closure rate, and length of stay significantly favored inborn patients. In multivariable analysis, birthplace was not a significant predictor of time to FEN. Gestational age, presence of atresia or necrosis, primary closure rate, and time to abdominal wall closure were significant predictors.

CONCLUSIONS:

Inborn patients had bowel coverage and definitive closure sooner with fewer days to full feeds and shorter length of stay. Birthplace appears to be important and should be considered in efforts to improve outcomes in patients with gastroschisis.

KEYWORDS:

Birth location; Birthplace; Gastroschisis; Outcomes; Regionalization

PMID:
25487481
DOI:
10.1016/j.jpedsurg.2014.09.019
[Indexed for MEDLINE]

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