Multi-institutional practice patterns and outcomes in uncomplicated gastroschisis: a report from the University of California Fetal Consortium (UCfC)
| Autor: | Lusk, Leslie A, Brown, Erin G, Overcash, Rachael T, Grogan, Tristan R, Keller, Roberta L, Kim, Jae H, Poulain, Francis R, Shew, Steve B, Uy, Cherry, DeUgarte, Daniel A, University of California Fetal Consortium |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Gastroplasty Universities Reproductive health and childbirth Pediatrics California Paediatrics and Reproductive Medicine Enteral Nutrition Uncomplicated Clinical Research Infant Mortality Humans Retrospective Studies Outcome Gastroschisis Pediatric Practice University of California Fetal Consortium Infant Disease Management Perinatal Period - Conditions Originating in Perinatal Period Newborn Good Health and Well Being Female Silo Digestive Diseases Institutional Practice |
| Zdroj: | Journal of pediatric surgery, vol 49, iss 12 |
| Popis: | Background/purposeGastroschisis is a resource-intensive birth defect without consensus regarding optimal surgical and medical management. We sought to determine best-practice guidelines by examining differences in multi-institutional practices and outcomes.MethodsSite-specific practice patterns were queried, and infant-maternal chart review was retrospectively performed for gastroschisis infants treated at 5 UCfC institutions (2007-2012). The primary outcome was length of stay. Univariate analysis was done to assess variation practices and outcomes by site. Multivariate models were constructed with site as an instrumental variable and with sites grouped by silo practice pattern adjusting for confounding factors.ResultsOf 191 gastroschisis infants, 164 infants were uncomplicated. Among uncomplicated patients, there were no deaths and only one case of necrotizing enterocolitis. Bivariate analysis revealed significant differences in practices and outcomes by site. Despite wide variations in practice patterns, there were no major differences in outcome among sites or by silo practice, after adjusting for confounding factors.ConclusionsWide variability exists in institutional practice patterns for infants with gastroschisis, but poor outcomes were not associated with expeditious silo or primary closure, avoidance of routine paralysis, or limited central line and antibiotic durations. Development of clinical pathways incorporating these practices may help standardize care and reduce health care costs. |
| Databáze: | OpenAIRE |
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