Title

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

Authors

Authors

K. Murthy; J. R. Evans; A. M. Bhatia; D. H. Rothstein; R. Wadhawan; I. Zaniletti; R. Rao; C. Thurm; A. M. Mathur; A. J. Piazza; J. E. Stein; K. M. Reber; B. L. Short; M. A. Padula; D. J. Durand; J. M. Asselin; E. K. Pallotto;F. D. Dykes

Comments

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Abbreviated Journal Title

J. Pediatr. Surg.

Keywords

Infant; Gastroschisis; Staged closure; Neonatal intensive care; Length; of stay; Children's Hospital Neonatal Database (CHND); Children's; Hospitals Neonatal Consortium; SHORT-BOWEL SYNDROME; PEDIATRIC-SURGERY NETWORK; SPRING-LOADED SILO; NATIONAL COHORT; NEONATAL CARE; UNITED-STATES; OUTCOMES; MANAGEMENT; PREDICTORS; REPAIR; Pediatrics; Surgery

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 (beta = 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. (C) 2014 Elsevier Inc. All rights reserved.

Journal Title

Journal of Pediatric Surgery

Volume

49

Issue/Number

8

Publication Date

1-1-2014

Document Type

Article

Language

English

First Page

1220

Last Page

1225

WOS Identifier

WOS:000340256200007

ISSN

0022-3468

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