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

      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.

      Key words

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      References

        • Alvarez S.M.
        • Burd R.S.
        Increasing prevalence of gastroschisis repairs in the United States: 1996–2003.
        J Pediatr Surg. 2007; 42: 943-946
        • Owen A.
        • Marven S.
        • Johnson P.
        • et al.
        Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes.
        J Pediatr Surg. 2010; 45: 1808-1816
        • Emil S.
        • Canvasser N.
        • Chen T.
        • et al.
        Contemporary 2-year outcomes of complex gastroschisis.
        J Pediatr Surg. 2012; 47: 1521-1528
        • Kassa A.-M.
        • Lilja H.E.
        Predictors of postnatal outcome in neonates with gastroschisis.
        J Pediatr Surg. 2011; 46: 2108-2114
        • Minkes R.K.
        • Langer J.C.
        • Mazziotti M.V.
        • et al.
        Routine insertion of a Silastic® spring-loaded silo for infants with gastroschisis.
        J Pediatr Surg. 2000; 35: 843-846
        • Allotey J.
        • Davenport M.
        • Njere I.
        • et al.
        Benefit of preformed silos in the management of gastroschisis.
        Pediatr Surg Int. 2007; 23: 1065-1069
        • Stark A.R.
        • American Academy of Pediatrics Committee on Fetus & Newborn
        Levels of neonatal care.
        Pediatrics. 2004; 114: 1341-1347
        • American Academy of Pediatrics Committee on Fetus & Newborn
        Levels of neonatal care.
        Pediatrics. 2012; 130: 587-597
        • Skarsgard E.D.
        • Claydon J.
        • Bouchard S.
        • et al.
        Canadian Pediatric Surgical Network: a population-based pediatric surgery network and database for analyzing surgical birth defects. The first 100 cases of gastroschisis.
        J Pediatr Surg. 2008; 43: 30-34
        • Weil B.R.
        • Leys C.M.
        • Rescorla F.J.
        The jury is still out: changes in gastroschisis management over the last decade are associated with both benefits and shortcomings.
        J Pediatr Surg. 2012; 47: 119-124
        • Schlatter M.
        • Norris K.
        • Uitvlugt N.
        • et al.
        Improved outcomes in the treatment of gastroschisis using a preformed silo and delayed repair approach.
        J Pediatr Surg. 2003; 38: 459-464
        • Jensen A.R.
        • Waldhausen J.H.T.
        • Kim S.S.
        The use of a spring-loaded silo for gastroschisis: impact on practice patterns and outcomes.
        Arch Surg. 2009; 144: 516-519
        • Weinsheimer R.L.
        • Yanchar N.L.
        • Bouchard S.B.
        • et al.
        Gastroschisis closure—does method really matter?.
        J Pediatr Surg. 2008; 43: 874-878
      1. Murthy K, Hall M, Pallotto EK, et al.: "The Children’s Hospitals Neonatal Database (CHND): an assessment of inter-rater agreement (IRA)", to the 2012 Pediatric Academic Societies’ Meetings, April 28–May 1, 2012, Boston, MA (Abstract #: #751047).

        • Cowan K.N.
        • Puligandla P.S.
        • Laberge J.M.
        • et al.
        The gastroschisis prognostic score: reliable outcome prediction in gastroschisis.
        J Pediatr Surg. 2012; 47: 1111-1117
        • Molik K.A.
        • Gingalewski C.A.
        • West K.W.
        • et al.
        Gastroschisis: a plea for risk categorization.
        J Pediatr Surg. 2001; 36: 51-55
        • Horan T.C.
        • Andrus M.
        • Dudeck M.A.
        CDC/NHSN surveillance definition of health careassociated infection and criteria for specific types of infections in the acute care setting.
        Am J Infect Control. 2008; 35: 309-332
        • Lin P.W.
        • Stoll B.J.
        Necrotising enterocolitis.
        Lancet. 2006; 368: 1271-1283
        • Duro D.
        • Kamin D.
        • Duggan C.
        Overview of pediatric short bowel syndrome.
        J Pediatr Gastroenterol Nutr. 2008; 47: S33-S36
        • Touloukian R.J.
        • Smith G.J.
        Normal intestinal length in preterm infants.
        J Pediatr Surg. 1983; 18: 720-723
        • Andorsky D.J.
        • Lund D.P.
        • Lillehei C.W.
        • et al.
        Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes.
        J Pediatr. 2001; 139: 27-33
        • Spencer A.U.
        • Neaga A.
        • West B.
        • et al.
        Pediatric short bowel syndrome: redefining predictors of success.
        Ann Surg. 2005; 242: 403-409
        • Quirós-Tejeira R.E.
        • Ament M.E.
        • Reyen L.
        • et al.
        Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: a 25-year experience.
        J Pediatr. 2004; 145: 157-163
        • Sandler A.
        • Lawrence J.
        • Meehan J.
        • et al.
        A “plastic” sutureless abdominal wall closure in gastroschisis.
        J Pediatr Surg. 2004; 39: 738-741
        • Riboh J.
        • Abrajano C.T.
        • Garber K.
        • et al.
        Outcomes of sutureless gastroschisis closure.
        J Pediatr Surg. 2009; 44: 1947-1951
        • Olsen I.E.
        • Groveman S.A.
        • Lawson M.L.
        • et al.
        New intrauterine growth curves based on United States data.
        Pediatrics. 2010; 125: e214-e224
        • Brown H.
        • Prescott R.
        Applied mixed models in medicine.
        West Sussex, England, John Wiley & Sons2006
        • Overton T.G.
        • Pierce M.R.
        • Gao H.
        • et al.
        Antenatal management and outcomes of gastroschisis in the U.K.
        Prenat Diagn. 2012; 32: 1256-1262
        • The Canadian Pediatric Surgical Network
        • Baird R.
        • Puligandla P.
        • et al.
        Infectious complications in the management of gastroschisis.
        Pediatr Surg Int. 2011; 28: 399-404
        • Aljahdali A.
        • Mohajerani N.
        • Skarsgard E.D.
        Canadian Pediatric Surgery Network (CAPSNet). Effect of timing of enteral feeding on outcome in gastroschisis.
        J Pediatr Surg. 2013; 48: 971-976
        • Tsai M.-H.
        • Huang H.-R.
        • Chu S.-M.
        • et al.
        Clinical features of newborns with gastroschisis and outcomes of different initial interventions: primary closure versus staged repair.
        Pediatr Neonatol. 2010; 51: 320-325
        • Aldrink J.H.
        • Caniano D.A.
        • Nwomeh B.C.
        • et al.
        Variability in gastroschisis management: a survey of North American pediatric surgery training programs.
        J Surg Res. 2012; 176: 159-163
        • Banyard D.
        • Ramones T.
        • Phillips S.E.
        • et al.
        Method to our madness: an 18-year retrospective analysis on gastroschisis closure.
        J Pediatr Surg. 2010; 45: 579-584
        • Safavi A.
        • Skarsgard E.
        • Butterworth S.
        Bowel-defect disproportion in gastroschisis: does the need to extend the fascial defect predict outcome?.
        Pediatr Surg Int. 2012; 28: 495-500
        • Houben C.
        • Davenport M.
        • Ade-Ajayi N.
        • et al.
        Closing gastroschisis: diagnosis, management, and outcomes.
        J Pediatr Surg. 2009; 44: 343-347
        • Bradnock T.J.
        • Marven S.
        • Owen A.
        • et al.
        Gastroschisis: one year outcomes from national cohort study.
        BMJ. 2011; 343: d6749-d6758
        • Engle W.A.
        • The American Academy of Pediatrics Committee of Fetus & Newborn
        Age terminology during the perinatal period.
        Pediatrics. 2004; 114: 1362-1364
        • Lao O.
        • Larison C.
        • Garrison M.
        • et al.
        Outcomes in neonates with gastroschisis in U.S. children's hospitals.
        Am J Perinatol. 2009; 27: 97-101
        • Davies B.W.
        • Stringer M.D.
        The survivors of gastroschisis.
        Arch Dis Child. 1997; 77: 158-160
        • Baird R.
        • Eeson G.
        • Safavi A.
        • et al.
        Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network.
        J Pediatr Surg. 2011; 46: 801-807