Primary versus Staged Repairs of Gastroschisis; Clinical Outcomes and Hospital Costs
Alex M. Lin, MD, Brendan R. McFall DO, Kevin P. Moriarty MD, Michael Tirabassi MD
Background: Both surgeon preference and judgement are major determinants of whether Gastroschisis is repaired primarily or in stages. We hypothesized that primary closure of gastroschisis would result in decreased need for ventilation, shorter hospitalization, and lower cost without an increased risk of necrotizing enterocolitis.
Methods: Retrospective cohort study of primary versus staged repairs of gastroschisis comparing outcomes, and costs associated with each type of repair recorded in the 2012 and 2016 KID database.
Results: Of the 2210 repairs, 1527 (69.1%) underwent a primary repair and 683 (30.9%) underwent a staged repair. There were no significant differences in gender, age, and race between the two cohorts (p>0.05). Staged repair was associated with longer median length of stay(33 days vs 40 days, p<0.001), and a significant increase in median total cost(,624 vs ,289, p<0.001). Staged repair was associated with higher rates of wound infection(10.7% vs 5.8%, p<0.001) and bacterial sepsis(26.7% vs 21.2%, p=0.005) but of the incidence of necrotizing enterocolitis was similar between groups(6.59% vs 5.57%, p=0.345). Multivariate logistic regression analysis showed that staged repair was found to be an independent risk factor for prolong ventilation(OR 2.13, 95% CI: 1.765 – 2.580).
Conclusion: We observed that primary closure of gastroschisis was associated with lower risk of prolong ventilation, bacterial sepsis, wound infection, hospital costs and length of stay without an increased risk of necrotizing enterocolitis. While there will always be infants that will require a staged repair, when feasible, primary closure of gastroschisis may offer a clinical and cost-conscious benefit.
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