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

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

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.

Original languageEnglish
Pages (from-to)1220-1225
Number of pages6
JournalJournal of Pediatric Surgery
Volume49
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • Children's Hospital Neonatal Database (CHND)
  • Children's Hospitals Neonatal Consortium
  • Gastroschisis
  • Infant
  • Length of stay
  • Neonatal intensive care
  • Staged closure

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