S. Burjonrappa1,2, A. Ivanovic2, S. Burjonrappa1,2 1Albert Einstein College Of Medicine,Bronx, NY, USA 2Saint Barnabas Medical Center,Livingston, NJ, USA
Introduction: Success rates of gastroschisis interventions have been increasingly examined but little data is available regarding the impact of the timing of these interventions as well as fetal delivery itself on outcomes. This study aimed to examine the relationships between overall outcomes of patients diagnosed with gastroschisis and timing of delivery (planned versus non planned) and mode of delivery (cesarean section versus vaginal delivery). The primary outcome evaluated was the length hospitalization, and secondary outcomes evaluated included: time to extubation, age at return of bowel function, and time to tolerance of oral feeds.
Methods: This work was performed as a ten-year retrospective chart analysis including patients from 2005 to 2013. Inclusion in the study required a pre-operative diagnosis and a surgical intervention for gastroschisis. We identified 29 patients of interest who were filtered based on availability of the specific timing of each intervention. Chi-square test was used to determine statistical differences amongst categorical variables and the student t-test was used to determine differences amongst continuous variables.
Results: The major factors influencing the Length of hospitalization were age at return of bowel function (p = 0.0213) and age at tolerance of oral feeds (p = 0.0116). Further early extubation was also correlated to a shorter hospital (p = 0.0003). Analysis of mode of delivery, comparing vaginal delivery to Cesarean section, showed that patients delivered by Cesarean section had a reduced length of hospitalization as compared to those delivered vaginally (p = 0.0080). Mode of delivery did not significantly impact the other patient outcomes but we did find that time to oral feeds was increased in those patients undergoing unplanned deliveries (p = 0.0176). No other outcomes were impacted by undergoing a planned versus unplanned gastroschisis delivery. Further, our results show a significant and positive correlation between birth weight and gestational age (p = 0.0164).
Conclusion: Our data suggests that patients delivered without prior planning will have an extended time to tolerance of oral feeds. In addition, we find that patients delivered by Cesarean section will have shorter lengths of hospitalizations. Factors influencing length of stay after gastroschisis, such as return of bowel function and time to tolerance of oral feeds may be related to mode and timing of delivery. Many present studies focus solely on the impact of silo and primary closure in determining gastroschisis outcomes. We recommend that future analysis of larger databases should focus also on peri-partum factors that may influence outcomes in gastroschisis.