Impact of disease-specific volume and hospital transfer on outcomes in gastroschisis
Copyright © 2018 Elsevier Inc. All rights reserved..
BACKGROUND: Gastroschisis, a surgical condition requiring complex interdisciplinary care, may benefit from treatment at higher volume centers. Recent studies on surgical volume and outcomes have conflicting findings.
METHODS: Data were collected prospectively on newborns ≥1500 g with gastroschisis born 2009-2015, admitted to 159 US centers, and separated into terciles based on number of annual gastroschisis repairs. Infants transferred after gastroschisis repair were excluded.
RESULTS: There were 4663 infants included: 307 from 53 low, 1201 from 55 medium, and 3155 from 51 high volume centers. Infants at high volume centers had higher rates of intestinal atresia (P = 0.04) and outborn status (P < 0.0001). Outborn infants (N = 1134) had higher rates of gastrostomy/jejunostomy placement (P < 0.001). Mortality was universally low (2.0% low, 2.4% medium, and 1.7% high; 2.0% outborn and 1.9% inborn). On multivariate analysis, mortality, sepsis rates, and length of stay did not differ by center volume. Outborn status was associated with longer length of stay (P = 0.001), not mortality or sepsis.
CONCLUSION: Infant characteristics and management vary based on gastroschisis surgical volume and transfer status. Center volume and early transfers were not associated with mortality. Further investigation to identify subsets of gastroschisis infants who would benefit from care at higher volume centers is warranted.
TYPE OF STUDY: Prognosis study.
LEVEL OF EVIDENCE: Level II.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:54 |
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| Enthalten in: |
Journal of pediatric surgery - 54(2019), 1 vom: 15. Jan., Seite 65-69 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hong, Charles R [VerfasserIn] |
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| Links: |
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| Themen: |
Gastroschisis |
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| Anmerkungen: |
Date Completed 04.03.2019 Date Revised 04.03.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jpedsurg.2018.10.034 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM289784107 |
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| 500 | |a Date Revised 04.03.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Gastroschisis, a surgical condition requiring complex interdisciplinary care, may benefit from treatment at higher volume centers. Recent studies on surgical volume and outcomes have conflicting findings | ||
| 520 | |a METHODS: Data were collected prospectively on newborns ≥1500 g with gastroschisis born 2009-2015, admitted to 159 US centers, and separated into terciles based on number of annual gastroschisis repairs. Infants transferred after gastroschisis repair were excluded | ||
| 520 | |a RESULTS: There were 4663 infants included: 307 from 53 low, 1201 from 55 medium, and 3155 from 51 high volume centers. Infants at high volume centers had higher rates of intestinal atresia (P = 0.04) and outborn status (P < 0.0001). Outborn infants (N = 1134) had higher rates of gastrostomy/jejunostomy placement (P < 0.001). Mortality was universally low (2.0% low, 2.4% medium, and 1.7% high; 2.0% outborn and 1.9% inborn). On multivariate analysis, mortality, sepsis rates, and length of stay did not differ by center volume. Outborn status was associated with longer length of stay (P = 0.001), not mortality or sepsis | ||
| 520 | |a CONCLUSION: Infant characteristics and management vary based on gastroschisis surgical volume and transfer status. Center volume and early transfers were not associated with mortality. Further investigation to identify subsets of gastroschisis infants who would benefit from care at higher volume centers is warranted | ||
| 520 | |a TYPE OF STUDY: Prognosis study | ||
| 520 | |a LEVEL OF EVIDENCE: Level II | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Gastroschisis | |
| 650 | 4 | |a Length of stay | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Sepsis | |
| 650 | 4 | |a Surgical volume | |
| 650 | 4 | |a Transfer | |
| 700 | 1 | |a Fullerton, Brenna S |e verfasserin |4 aut | |
| 700 | 1 | |a Han, Sam M |e verfasserin |4 aut | |
| 700 | 1 | |a Morrow, Kate A |e verfasserin |4 aut | |
| 700 | 1 | |a Edwards, Erika M |e verfasserin |4 aut | |
| 700 | 1 | |a Soll, Roger F |e verfasserin |4 aut | |
| 700 | 1 | |a Jaksic, Tom |e verfasserin |4 aut | |
| 700 | 1 | |a Horbar, Jeffrey D |e verfasserin |4 aut | |
| 700 | 1 | |a Modi, Biren P |e verfasserin |4 aut | |
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