Primary Versus Staged Repairs of Gastroschisis; Clinical Outcomes and Hospital Costs in 2016
*Alex M Lin, *Brendan R McFall, Kevin P Moriarty, Michael Tirabassi
Baystate Medical Center, Springfield, MA
Objective: We hypothesized that primary closure of gastroschisis would result in decreased need for ventilation, shorter hospitalization, and lower costs without increased risk of necrotizing enterocolitis compared to staged repairs.
Design: Retrospective cohort study of primary versus staged repairs of gastroschisis in 2016, comparing outcomes and costs associated with each type of repair.
Setting: 4,200 U.S. community, non-rehabilitation hospitals participating in Healthcare Cost Utilization Project.Patients: 957 infants with ICD-10-PCS codes for surgical repairs of gastroschisis in 2016 KIDís database, 762 had primary repair and 195 staged repairs.
Interventions: Statistical analysis using T-test, Fisherís Exact, and Chi-squared test.
Main Outcome Measures: Ventilatory Assistance for > 96 hours, Hospital Costs, Necrotizing Enterocolitis, Length of Stay.
Results: Of the 957 repairs, there were no significant differences in gender, age, and race between the two cohorts(p>0.05). The majority of staged repairs were completed by the second operation(178, 91.2%) while 17 cases(8.7%) required three or more procedures. Staged repair was associated with longer hospitalization(39 days vs 34 days, p<0.001), and a trend towards increased cost($322,404 vs $287,413p=0.202). Both cohorts had similarly low rates of surgical wound infection(5.8% vs 7.7%, p=0.358) and necrotizing enterocolitis(5.7% vs 7.2%, p=0.463) in 2016. Patients undergoing staged repairs were more likely to require ventilatory assistance for > 96 hours(40.0% vs 25.6%, p<0.001).
Conclusions: We observed that primary closure of gastroschisis was associated with a shorter hospital stay, lower incidence of requiring prolonged ventilatory assistance, and a trend toward lower cost without increased risk of necrotizing enterocolitis. When feasible based on the infantís anatomy, primary closure of gastroschisis may offer clinical and cost-conscious benefits.
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