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Factors affecting the outcome in patients with gastroschisis: how important is immediate repair?
Insights
Immediate surgical repair of gastroschisis (a birth defect) in the delivery room significantly shortens recovery times. This approach leads to reduced need for mechanical ventilation and parenteral nutrition, and shorter hospital stays for infants.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis repair has historically aimed for early intervention, often in the delivery room.
- This study evaluates outcomes over 12 years to assess the impact of immediate repair and other factors.
Purpose of the Study:
- To evaluate the effect of immediate repair versus delayed repair on gastroschisis outcomes.
- To compare outcomes based on the location and type of surgical repair.
- To identify factors influencing recovery time and hospital stay.
Main Methods:
- Retrospective review of 87 gastroschisis cases (1998-2009).
- Analysis of repair timing (immediate vs. delayed), location (delivery room vs. operating room), and type (primary vs. staged).
- Evaluation of outcomes including mechanical ventilation duration, parenteral nutrition duration, and hospital length of stay.
Main Results:
- Immediate repair (PR) was associated with shorter durations on mechanical ventilation (MV) and total parenteral nutrition (TPN).
- Primary repair (PR) also correlated with shorter hospital stays (less than 3 weeks).
- Associated anomalies and degree of "peel" on the intestines influenced outcomes, with fewer anomalies and less peel generally leading to better results.
Conclusions:
- Immediate repair of gastroschisis after delivery is beneficial.
- Shorter durations on assisted ventilation and parenteral nutrition, and reduced hospital stays are key benefits.
- The timing and type of surgical repair significantly impact patient recovery trajectories.
Background:
Since 30 years, we have attempted to repair gastroschisis as early as possible, often even in the delivery room. We examined 12 recent years of patient records to evaluate the effect of immediate repair and other factors on the outcome of gastroschisis.
Methods:
We reviewed the medical records of patients presenting with gastroschisis (87) at the Children's Hospital of Michigan between 1998 and 2009. Data were evaluated specifically to determine the effect of the place of repair [obstetric hospital ("DR") vs. children's hospital ("OR")], the time of repair [less than an hour after delivery ("IR") or more than one hour ("ER")], and the type of repair [primary fascial repair and skin closure ("PR") vs. staged repair ("SR")].
Results:
Patients in the PR group were more likely to spend one week or less on MV (66% in PR vs. 11% in SR, p<0.01). Patients in the DR group were more likely to spend 2 weeks or less on TPN, as were patients in the PR group (51% in PR vs. 17% in SR, p<0.01). Patients in the PR group were more likely to stay in hospital for less than 3 weeks, but the IR and ER groups had almost same hospital stay. Major associated anomalies were present in 19 patients (29%). These patients and those with little or no peel tended to outperform those with peel in each of our outcome measures.
Conclusion:
Repair immediately after delivery is beneficial in terms of achieving primary closure of the defect, leading to shorter times on assisted ventilation and parenteral nutrition, and shorter hospital stays.
