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Trends in incidence and outcomes of gastroschisis in the United States: analysis of the national inpatient sample 2010–2014

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Abstract

Purpose

Gastroschisis is a severe congenital anomaly associated with a significant morbidity and mortality. There are limited temporal trend data on incidence, mortality, length of stay, and hospital cost of gastroschisis. Our aim was to study these temporal trends using the National Inpatient Sample (NIS).

Methods

We identified all neonatal admissions with a diagnosis of gastroschisis within the NIS from 2010 through 2014. We limited admission age to ≤ 28 days and excluded all those transferred to other hospitals. We estimated gastroschisis incidence, mortality, length of hospital stay, and cost of hospitalization. For continuous variables, trends were analyzed using survey regression. Cochrane–Armitage trend test was used to analyze trends for categorical variables. P < 0.05 was considered as significant.

Results

The incidence of gastroschisis increased from 4.5 to 4.9/10,000 live births from 2010 through 2014 (P = 0.01). Overall mortality was 3.5%, median length of stay was 35 days (95% CI 26–55 days), and median cost of hospitalization was $75,859 (95% CI $50,231–$122,000). After adjusting for covariates, there was no statistically significant change in mortality (OR = 1.13; 95% CI 0.87–1.48), LOS (β = − 2.1 ± 3.5; 95% CI − 9.0 to 4.8) and hospital cost (β = − 2.137 ± 10.813; 95% CI − 23,331 to 19,056) with each calendar year increase on multivariate logistic regression analysis.

Conclusion

The incidence of neonates with gastroschisis increased between 2010 and 2014. Incidence was highest in the West. No difference in mortality and resource utilization was observed.

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References

  1. Feldkamp ML, Carey JC, Sadler TW (2007) Development of gastroschisis: review of hypotheses, a novel hypothesis, and implications for research. Am J Med Genet A 143A:639–652. https://doi.org/10.1002/ajmg.a.31578

    Article  PubMed  Google Scholar 

  2. Benjamin BG, Ethen MK, Van Hook CL et al (2009) Gastroschisis prevalence in Texas 1999–2003. Birth Defects Res A Clin Mol Teratol. https://doi.org/10.1002/bdra.20642

    Article  Google Scholar 

  3. Torfs CP, Katz EA, Bateson TF et al (1996) Maternal medications and environmental exposures as risk factors for gastroschisis. Teratology 54:84–92. https://doi.org/10.1002/(SICI)1096-9926(199606)54:2<84::AID-TERA4>3.0.CO;2-4

    Article  PubMed  CAS  Google Scholar 

  4. Werler MM, Sheehan JE, Mitchell AA (2003) Association of vasoconstrictive exposures with risks of gastroschisis and small intestinal atresia. Epidemiology 14:349–354

    PubMed  Google Scholar 

  5. Werler MM, Sheehan JE, Mitchell AA (2002) Maternal medication use and risks of gastroschisis and small intestinal atresia. Am J Epidemiol 155:26–31

    Article  PubMed  Google Scholar 

  6. Draper ES, Rankin J, Tonks AM et al (2008) Recreational drug use: a major risk factor for gastroschisis? Am J Epidemiol 167:485–491. https://doi.org/10.1093/aje/kwm335

    Article  PubMed  Google Scholar 

  7. Paranjothy S, Broughton H, Evans A et al (2012) The role of maternal nutrition in the aetiology of gastroschisis: an incident case-control study. Int J Epidemiol 41:1141–1152. https://doi.org/10.1093/ije/dys092

    Article  PubMed  Google Scholar 

  8. Robledo-Aceves M, Bobadilla-Morales L, Mellín-Sánchez EL et al (2015) Prevalence and risk factors for gastroschisis in a public hospital from west México. Congenit Anom (Kyoto) 55:73–80. https://doi.org/10.1111/cga.12087

    Article  Google Scholar 

  9. Chabra S, Gleason CA, Seidel K, Williams MA (2011) Rising prevalence of gastroschisis in Washington State. J Toxicol Environ Heal Part A 74:336–345. https://doi.org/10.1080/15287394.2011.534424

    Article  CAS  Google Scholar 

  10. Laughon M, Meyer R, Bose C et al (2003) Rising birth prevalence of gastroschisis. J Perinatol 23:291–293. https://doi.org/10.1038/sj.jp.7210896

    Article  PubMed  Google Scholar 

  11. Vu LT, Nobuhara KK, Laurent C, Shaw GM (2008) Increasing prevalence of gastroschisis: population-based study in California. J Pediatr 152:807–811. https://doi.org/10.1016/j.jpeds.2007.11.037

    Article  PubMed  Google Scholar 

  12. Molik KA, Gingalewski CA, West KW et al (2001) Gastroschisis: a plea for risk categorization. J Pediatr Surg 36:51–55. https://doi.org/10.1053/jpsu.2001.20004

    Article  PubMed  CAS  Google Scholar 

  13. Jones AM, Isenburg J, Salemi JL et al (2016) Increasing prevalence of gastroschisis —14 states, 1995–2012. MMWR Morb Mortal Wkly Rep 65:23–26. https://doi.org/10.15585/mmwr.mm6502a2

    Article  PubMed  Google Scholar 

  14. Kirby RS, Marshall J, Tanner JP et al (2013) Prevalence and correlates of Gastroschisis in 15 states, 1995 to 2005. Obstet Gynecol 122:275–281. https://doi.org/10.1097/AOG.0b013e31829cbbb4

    Article  PubMed  PubMed Central  Google Scholar 

  15. Castilla EE, Mastroiacovo P, Orioli IM (2008) Gastroschisis: international epidemiology and public health perspectives. Am J Med Genet Part C Semin Med Genet 148C:162–179. https://doi.org/10.1002/ajmg.c.30181

    Article  PubMed  Google Scholar 

  16. Hook-Dufresne DM, Yu X, Bandla V et al (2015) The economic burden of gastroschisis: costs of a birth defect. J Surg Res 195:16–20. https://doi.org/10.1016/j.jss.2015.01.036

    Article  PubMed  Google Scholar 

  17. Arth AC, Tinker SC, Simeone RM et al (2017) Inpatient hospitalization costs associated with birth defects among persons of all ages—United States, 2013. MMWR Morb Mortal Wkly Rep 66:41–46. https://doi.org/10.15585/mmwr.mm6602a1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Centers for Disease Control and Prevention (CDC) (2007) Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defects—United States, 2003. MMWR Morb Mortal Wkly Rep 56:25–29

    Google Scholar 

  19. Lao O, Larison C, Garrison M et al (2010) Outcomes in neonates with gastroschisis in U.S. children’s hospitals. Am J Perinatol 27:097–101. https://doi.org/10.1055/s-0029-1241729

    Article  Google Scholar 

  20. Rockville M, Agency for Healthcare Research and Quality (2016) HCUP-US Databases. Healthcare Cost and Utilization Project (HCUP). https://www.hcup-us.ahrq.gov/databases.jsp. Accessed 24 Mar 2017

  21. Wu C-P, Chen Y, Wang M-J, Pinelis E (2017) National trends in admission for aspiration pneumonia in the United States, 2002–2012. Ann Am Thorac Soc 14:874–879. https://doi.org/10.1513/AnnalsATS.201611-867OC

    Article  PubMed  Google Scholar 

  22. Desai D, Mehta D, Mathias P et al (2018) Health care utilization and burden of diabetic ketoacidosis in the U.S. Over the past decade: a nationwide analysis. Diabetes Care. https://doi.org/10.2337/dc17-1379

    Article  PubMed  Google Scholar 

  23. Nelson JS, Strassle PD (2018) Regional differences in right versus left congenital heart disease diagnoses in neonates in the United States. Birth Defects Res 110:325–335. https://doi.org/10.1002/bdr2.1140

    Article  PubMed  CAS  Google Scholar 

  24. Seo Y-J, Rudasill SE, Sanaiha Y et al (2018) A nationwide study of treatment modalities for thoracic aortic injury. Surgery. https://doi.org/10.1016/j.surg.2018.04.015

    Article  PubMed  Google Scholar 

  25. Foster CH, Karsy M, Jensen MR et al (2018) Trends and cost-analysis of lower extremity nerve injury using the national inpatient sample. Neurosurgery. https://doi.org/10.1093/neuros/nyy265

    Article  PubMed  Google Scholar 

  26. Rogowski J, Green NS, Steiner CA et al (1998) Cost-effectiveness of care for very low birth weight infants. Pediatrics 102:35–43. https://doi.org/10.1542/peds.102.1.35

    Article  PubMed  CAS  Google Scholar 

  27. Kourtis AP, Bansil P, Posner SF et al (2007) Trends in hospitalizations of HIV-infected children and adolescents in the United States: analysis of data from the 1994–2003 Nationwide Inpatient Sample. Pediatrics 120:e236–e243. https://doi.org/10.1542/peds.2006-3268

    Article  PubMed  Google Scholar 

  28. HCUP Methods Series Using the HCUP National Inpatient Sample to Estimate Trends (2018) (Revised 12/15/15) Report # 2006-05. http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp. Accessed 28 Feb 2018

  29. Burke BL, Robbins JM, Bird T, Mac et al (2009) Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988–2005. Pediatrics 123:524–532. https://doi.org/10.1542/peds.2007-2915

    Article  PubMed  Google Scholar 

  30. Tashiro J, Wang B, Sola JE et al (2014) Patent ductus arteriosus ligation in premature infants in the United States. J Surg Res 190:613–622. https://doi.org/10.1016/j.jss.2014.02.003

    Article  PubMed  Google Scholar 

  31. McGovern PM, Nachreiner NM, Holl JL et al (2016) The national children’s study: early recruitment outcomes using the direct outreach approach. Pediatrics 137(Suppl 4):S231–S238. https://doi.org/10.1542/peds.2015-4410D

    Article  Google Scholar 

  32. Armstrong-Wells J, Johnston SC, Wu YW et al (2009) Prevalence and predictors of perinatal hemorrhagic stroke: results from the kaiser pediatric stroke study. Pediatrics 123:823–828. https://doi.org/10.1542/peds.2008-0874

    Article  PubMed  Google Scholar 

  33. United States Department of Health and Human Services (US DHHS) (2017) Centers for Disease Control (CDC) NC for HS (NCHS) Natality public use data 2000–2014, on CDC Wonder Online Database. https://wonder.cdc.gov/natality.html. Accessed 3 Jan 2017

  34. Bergholz R, Boettcher M, Reinshagen K, Wenke K (2014) Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality—a systematic review and meta-analysis. J Pediatr Surg 49:1527–1532. https://doi.org/10.1016/j.jpedsurg.2014.08.001

    Article  PubMed  Google Scholar 

  35. Lap CCMM, Brizot ML, Pistorius LR et al (2016) Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis. Early Hum Dev 103:209–218. https://doi.org/10.1016/j.earlhumdev.2016.10.002

    Article  PubMed  Google Scholar 

  36. Youssef F, Cheong LHA, Emil S, Canadian Pediatric Surgery Network (CAPSNet) (2016) Gastroschisis outcomes in North America: a comparison of Canada and the United States. J Pediatr Surg 51:891–895. https://doi.org/10.1016/j.jpedsurg.2016.02.046

    Article  PubMed  Google Scholar 

  37. Gurien LA, Dassinger MS, Burford JM et al (2017) Does timing of gastroschisis repair matter? A comparison using the ACS NSQIP pediatric database. J Pediatr Surg 52:1751–1754. https://doi.org/10.1016/j.jpedsurg.2017.02.008

    Article  PubMed  Google Scholar 

  38. Rockville MHCUP, Agency for Healthcare Research and Quality. Cost-to-charge ratio files (CCR). Healthcare Cost and Utilization Project (HCUP). https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp. Accessed 22 Dec 2017

  39. U.S. Bureau of Labor Statistics CPI Inflation Calculator (2017) https://www.bls.gov/data/inflation_calculator.htm. Accessed 22 Dec 2017

  40. Chu B, Steiner C, Houchens R (2007) Hierarchical Modeling using HCUP Data Report# 2007-01. In: HCUP Methods Ser. https://www.hcup-us.ahrq.gov/reports/methods/2007_01.pdf. Accessed 22 Dec 2017

  41. Loane M, Dolk H, Bradbury I et al (2007) Increasing prevalence of gastroschisis in Europe 1980–2002: a phenomenon restricted to younger mothers? Paediatr Perinat Epidemiol 21:363–369. https://doi.org/10.1111/j.1365-3016.2007.00820.x

    Article  PubMed  Google Scholar 

  42. Martin JA, Hamilton BE, Ventura SJ et al (2002) Births: final data for 2000. Natl Vital Stat Rep 50:1–101

    PubMed  Google Scholar 

  43. Hamilton BE, Martin JA, Osterman MJK et al (2015) Births: final data for 2014. Natl Vital Stat Rep 64:1–64

    PubMed  Google Scholar 

  44. Centers for Disease Control and Prevention (CDC) (2008) Smoking prevalence among women of reproductive age—United States, 2006. MMWR Morb Mortal Wkly Rep 57:849–852

    Google Scholar 

  45. Murin S, Rafii R, Bilello K (2011) Smoking and smoking cessation in pregnancy. Clin Chest Med 32:75–91. https://doi.org/10.1016/j.ccm.2010.11.004

    Article  PubMed  Google Scholar 

  46. Jamal A, Agaku IT, O’Connor E et al (2014) Current cigarette smoking among adults—United States, 2005–2013. MMWR Morb Mortal Wkly Rep 63:1108–1112. doi: mm6347a4 [pii]

    PubMed  PubMed Central  Google Scholar 

  47. Morrison JJ, Chitty LS, Peebles D, Rodeck CH (2005) Recreational drugs and fetal gastroschisis: maternal hair analysis in the peri-conceptional period and during pregnancy. BJOG An Int J Obstet Gynaecol 112:1022–1025. https://doi.org/10.1111/j.1471-0528.2005.00655.x

    Article  Google Scholar 

  48. Weinsheimer RL, Yanchar NL, Canadian Pediatric Surgical Network (2008) Impact of maternal substance abuse and smoking on children with gastroschisis. J Pediatr Surg 43:879–883. https://doi.org/10.1016/j.jpedsurg.2007.12.032

    Article  PubMed  Google Scholar 

  49. Center for Behavioral Health Statistics. Results from the 2013 National Survey on Drug Use and Health: Summary of National Finding. https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf. Accessed 22 Dec 2017

  50. Abdullah F, Arnold MA, Nabaweesi R et al (2007) Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4344 patients. J Perinatol 27:50–55. https://doi.org/10.1038/sj.jp.7211616

    Article  PubMed  CAS  Google Scholar 

  51. Skarsgard ED, Claydon J, Bouchard S et al (2008) 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 43:30–34. https://doi.org/10.1016/j.jpedsurg.2007.09.011

    Article  PubMed  Google Scholar 

  52. Fullerton BS, Velazco CS, Sparks EA et al (2017) Contemporary outcomes of infants with gastroschisis in North America: a multicenter cohort study. J Pediatr 188:192–197.e6. https://doi.org/10.1016/j.jpeds.2017.06.013

    Article  PubMed  Google Scholar 

  53. Dubrovsky G, Sacks GD, Friedlander S, Lee S (2017) Understanding the relationship between hospital volume and patient outcomes for infants with gastroschisis. J Pediatr Surg 52:1977–1980. https://doi.org/10.1016/j.jpedsurg.2017.08.065

    Article  PubMed  Google Scholar 

  54. Aldrink JH, Caniano DA, Nwomeh BC (2012) Variability in gastroschisis management: a survey of North American pediatric surgery training programs. J Surg Res 176:159–163. https://doi.org/10.1016/j.jss.2011.05.012

    Article  PubMed  Google Scholar 

  55. Lusk LA, Brown EG, Overcash RT et al (2014) Multi-institutional practice patterns and outcomes in uncomplicated gastroschisis: a report from the University of California Fetal Consortium (UCfC). J Pediatr Surg 49:1782–1786. https://doi.org/10.1016/j.jpedsurg.2014.09.018

    Article  PubMed  PubMed Central  Google Scholar 

  56. Haddock C, Al Maawali AG, Ting J et al (2018) Impact of multidisciplinary standardization of care for gastroschisis: treatment, outcomes, and cost. J Pediatr Surg 53:892–897. https://doi.org/10.1016/j.jpedsurg.2018.02.013

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Texas Tech University Health Sciences Center, 1400 S Coulter Street, Amarillo, TX, 79106, USA

    Parth Bhatt & Sumesh Parat

  2. Mercy Health, 3300 Mercy Health Blvd, Cincinnati, OH, 45221, USA

    Anusha Lekshminarayanan

  3. University of Miami, 1611, NW 12th Avenue, Miami, FL, 33136, USA

    Keyur Donda & Fredrick Dapaah-Siakwan

  4. Rutgers New Jersey Medical School, 150 Bergen Street UH-I-248, Newark, NJ, 07103, USA

    Badal Thakkar

  5. Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Shilpi Chabra & Zeenia Billimoria

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  1. Parth Bhatt
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Correspondence to Zeenia Billimoria.

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Bhatt, P., Lekshminarayanan, A., Donda, K. et al. Trends in incidence and outcomes of gastroschisis in the United States: analysis of the national inpatient sample 2010–2014. Pediatr Surg Int 34, 919–929 (2018). https://doi.org/10.1007/s00383-018-4308-3

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