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Failure of primary closure predicts prolonged length of stay in gastroschisis patients

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Abstract

Purpose

Current literature regarding outcomes of gastroschisis closure methods do not highlight differences in patients who successfully undergo primary closure with those who fail and require silo placement. We hypothesize that failure of primary closure has significant effects on clinical outcomes such as length of stay and time to enteral feeding.

Methods

We conducted a retrospective review between 2009 and 2018 of gastroschisis patients at a tertiary pediatric referral hospital. We compared patients successfully undergoing primary closure to patients who failed an initial primary closure attempt. Bivariate and multivariate linear regression models were used to assess the association of closure method on clinical outcomes.

Results

Sixty-eight neonates were included for analysis, with 44 patients who underwent primary closure and 24 who failed primary closure. On multivariate regression analysis, primary closure patients had shorter estimated time to starting and to full enteral feeds and decreased LOS as compared to those who failed primary closure. Two patients (4.44%) had complications related to primary closure.

Conclusion

Patients able to undergo primary closure for gastroschisis were more likely to have a shorter length of stay, shorter time to enteral feeds, and use much fewer medical resources. Initial primary closure is a safe method for most patients.

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References

  1. Stallings EB, Isenburg JL, Short TD et al (2019) Population-based birth defects data in the United States, 2012–2016: a focus on abdominal wall defects. Birth Defects Res 111:1436–1447

    Article  CAS  Google Scholar 

  2. Kunz SN, Tieder JS, Whitlock K et al (2013) Primary fascial closure versus staged closure with silo in patients with gastroschisis: a meta-analysis. J Pediatr Surg 48:845–857

    Article  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. Murthy K, Evans JR, Bhatia AM et al (2014) The association of type of surgical closure on length of stay among infants with gastroschisis born>/=34 weeks’ gestation. J Pediatr Surg 49:1220–1225

    Article  Google Scholar 

  5. Banyard D, Ramones T, Phillips SE et al (2010) Method to our madness: an 18-year retrospective analysis on gastroschisis closure. J Pediatr Surg 45:579–584

    Article  Google Scholar 

  6. Keene ON (1995) The log transformation is special. Stat Med 14:811–819

    Article  CAS  Google Scholar 

  7. Duan N (1983) Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc 78:605–610

    Article  Google Scholar 

  8. Hawkins RB, Raymond SL, St Peter SD et al (2019) Immediate versus silo closure for gastroschisis: results of a large multicenter study. J Pediatr Surg S0022–3468:30509–30513

    Google Scholar 

  9. Molik KA, Gingalewski CA, West KW et al (2001) Gastroschisis: a plea for risk categorization. J Pediatr Surg 36:51–55

    Article  CAS  Google Scholar 

  10. Kidd JN Jr, Jackson RJ, Smith SD et al (2003) Evolution of staged versus primary closure of gastroschisis. Ann Surg 237:759–764 ((discussion 764-755))

    PubMed  PubMed Central  Google Scholar 

  11. Poola AS, Aguayo P, Fraser JD et al (2019) Primary closure versus bedside silo and delayed closure for gastroschisis: a truncated prospective randomized trial. Eur J Pediatr Surg 29:203–208

    Article  Google Scholar 

  12. Petrosyan M, Sandler AD (2018) Closure methods in gastroschisis. Semin Pediatr Surg 27:304–308

    Article  Google Scholar 

  13. DeUgarte DA, Calkins KL, Guner Y et al (2020) Adherence to and outcomes of a University-Consortium gastroschisis pathway. J Pediatr Surg 55:45–48

    Article  Google Scholar 

  14. Zalles-Vidal C, Peñarrieta-Daher A, Bracho-Blanchet E et al (2018) A Gastroschisis bundle: effects of a quality improvement protocol on morbidity and mortality. J Pediatr Surg 53:2117–2122

    Article  Google Scholar 

  15. Neu J, Walker WA (2011) Necrotizing enterocolitis. N Engl J Med 364:255–264

    Article  CAS  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

    Article  Google Scholar 

  17. Wong M, Oron AP, Faino A et al (2020) Variation in hospital costs for gastroschisis closure techniques. Am J Surg 219:764–768

    Article  Google Scholar 

  18. Kumar JA, Teckman JH (2015) Controversies in the mechanism of total parenteral nutrition induced pathology. Children (Basel) 2:358–370

    Google Scholar 

  19. Snyder AN, Burjonrappa S (2020) Central line associated blood stream infections in gastroschisis patients: a nationwide database analysis of risks, outcomes, and disparities. J Pediatr Surg 55:286–291

    Article  Google Scholar 

  20. Hartman M, Martin AB, Benson J et al (2020) National health care spending in 2018: growth driven by accelerations in medicare and private insurance spending. Health Aff (Millwood) 39:8–17

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Saunders Lin, Aaron Cunningham & Nicholas Hamilton

  2. Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Caroline Stephens

Authors
  1. Saunders Lin
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  2. Caroline Stephens
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  3. Aaron Cunningham
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  4. Nicholas Hamilton
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Correspondence to Saunders Lin.

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Lin, S., Stephens, C., Cunningham, A. et al. Failure of primary closure predicts prolonged length of stay in gastroschisis patients. Pediatr Surg Int 37, 77–83 (2021). https://doi.org/10.1007/s00383-020-04772-3

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  • DOI: https://doi.org/10.1007/s00383-020-04772-3

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