Impact of disease-specific volume and hospital transfer on outcomes in gastroschisis
| Autor: | Jeffrey D. Horbar, Kate A. Morrow, Sam M. Han, Erika M. Edwards, Tom Jaksic, Biren P. Modi, Brenna S. Fullerton, Roger F. Soll, Charles R. Hong |
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| Rok vydání: | 2018 |
| Předmět: |
Disease specific
Male Patient Transfer Pediatrics medicine.medical_specialty Databases Factual Prognosis study Postoperative Complications Risk Factors Sepsis medicine Humans Transfer status Prospective Studies Digestive System Surgical Procedures Gastroschisis business.industry Intestinal atresia Infant Newborn Infant General Medicine Evidence-based medicine Length of Stay medicine.disease Prognosis United States Survival Rate Treatment Outcome Pediatrics Perinatology and Child Health Surgery Female Level ii business Hospitals High-Volume Volume (compression) |
| Zdroj: | Journal of pediatric surgery. 54(1) |
| ISSN: | 1531-5037 |
| Popis: | 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.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.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.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.Prognosis study.Level II. |
| Databáze: | OpenAIRE |
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