Implementing a standardized gastroschisis protocol significantly increases the rate of primary sutureless closure
Shahrzad Joharifard1, Maeve O'Neill Trudeau2, Shin Miyata3
1The University of British Columbia, Department of Surgery, Vancouver, British Columbia, Canada V6H3V4.
Insights
Implementing a standardized gastroschisis protocol significantly increased bedside and sutureless closures, reducing mechanical ventilation duration in neonates. This approach improved outcomes without increasing complications.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Protocol Optimization
Background:
- Gastroschisis, a congenital abdominal wall defect, requires specialized surgical management.
- Standardized care protocols have demonstrated benefits in various pediatric surgical conditions.
- An institution implemented a multidisciplinary gastroschisis practice bundle in 2013.
Purpose of the Study:
- To evaluate the impact of a standardized gastroschisis protocol on closure type.
- To assess the effect of the protocol on early clinical outcomes in gastroschisis patients.
Main Methods:
- Retrospective review of uncomplicated gastroschisis patients from 2008-2019.
- Comparison of patients treated before and after protocol implementation.
- Multivariate logistic regression to analyze closure location, method, and success rates.
Main Results:
- The proportion of bedside closures increased from 35.3% to 95.4% (p < 0.01).
- Sutureless closures rose significantly from 32.5% to 71.0% (p < 0.01).
- Median mechanical ventilation decreased from 4 to 2 days (p < 0.01), with no increase in complications.
Conclusions:
- A standardized gastroschisis protocol effectively increased immediate bedside and sutureless closures.
- The protocol led to a significant reduction in mechanical ventilation duration.
- Implementation of the protocol improved outcomes without adverse effects on postoperative complications.
Purpose:
Standardized protocols have been shown to improve outcomes in several pediatric surgical conditions. We implemented a multi-disciplinary gastroschisis practice bundle at our institution in 2013. We sought to evaluate its impact on closure type and early clinical outcomes.
Methods:
We performed a retrospective review of uncomplicated gastroschisis patients treated at our institution between 2008-2019. Patients were divided into two groups: pre- and post-protocol implementation. Multivariate logistic regression was used to compare closure location, method, and success.
Results:
Neonates (pre-implementation n = 53, post-implementation n = 43) were similar across baseline variables. Successful immediate closure rates were comparable (75.5% vs. 72.1%, p = 0.71). The proportion of bedside closures increased significantly after protocol implementation (35.3% vs. 95.4%, p < 0.01), as did the proportion of sutureless closures (32.5% vs. 71.0%, p < 0.01). Median postoperative mechanical ventilation decreased significantly (4 days IQR [3, 5] vs. 2 days IQR [1, 3], p < 0.01). Postoperative complications and duration of parenteral nutrition were equivalent. After controlling for potential confounding, infants in the post-implementation group had a 44.0 times higher odds of undergoing bedside closure (95% CI: 9.0, 215.2, p < 0.01) and a 7.7 times higher odds of undergoing sutureless closure (95% CI: 2.3, 25.1, p < 0.01).
Conclusions:
Implementing a standardized gastroschisis protocol significantly increased the proportion of immediate bedside sutureless closures and decreased the duration of mechanical ventilation, without increasing postoperative complications. Level of Evidence III Type of Study Retrospective comparative study.
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