J. E. Sola1, E. A. Perez1, J. Parreco1, J. Tashiro1 1University Of Miami,Surgery,Miami, FL, USA
Introduction: We hypothesized that clinical outcomes following gastroschisis repair are related to gestational age (GA).
Methods: We queried the Kids’ Inpatient Database (2003-2012) for infants undergoing surgical treatment of gastroschisis (ICD-9-CM procedure code 54.71). Bivariate analysis compared outcomes associated with birth at ≥37 wk, ≥35 to <37 wk, and <35 wk GA.
Results: Overall, 4,437 cases of gastroschisis repair were identified in the dataset. Infants were born at GA ≥37 wk (12%), ≥35 to <37 wk (55%), and <35 wk (33%) GA. Birth weight was most commonly 2000-2499g (39%), followed by ≥2500g (23%), and 1750-1999g (13%). Infants were most commonly Caucasian (53%) and male (51%).
For infants born at ≥37 wk, procedure-specific complications were 2.3 (1.3, 3.9) times more likely vs. vs. ≥35 to <37 wk GA, p=0.002. No difference in rates of wound disruption, wound infection, blood transfusion, reoperation, sepsis, pneumonia, or post-procedural hemorrhage were detected. Length of stay (LOS) did not differ significantly.
For infants born at <35 wk, wound disruptions were 1.6 (1.1, 2.2) times more likely vs. ≥35 to <37 wk GA, p=0.006. Blood transfusions were 1.7 (1.4, 1.9) times more likely, p<0.001. Reoperations were 1.8 (1.1, 3.1) times more likely, p=0.023. Sepsis was 1.4 (1.1, 1.8) times more likely, p=0.007. Pneumonia was 2.0 (1.0, 3.9) times more likely, p=0.037. LOS for <35 wk (57±45 days) was longer vs. ≥35 to <37 wk GA (42±32 days), p<0.001. No difference in rates of wound infection, post-procedural hemorrhage, or procedure-specific complications were detected.
Conclusion: On a comparison of gastroschisis repairs performed for infants born at full- or pre-term, complications rates are higher for infants born at <35 wk vs. ≥35 to <37 wk GA. Procedure-specific complications however, were higher for infants born at ≥37 wk vs. ≥35 to <37 wk GA. Risk-adjusted analyses will provide further detail regarding the relationship between GA and outcomes after gastroschisis repair.