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Relationship between volume and outcome for gastroschisis: A systematic review
Johannes Morche1, Tim Mathes2, Anja Jacobs3
1Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building, 38, 51109, Cologne, Germany; Medical Consultancy Department, Federal Joint Committee, Gutenbergstraße 13, 10587, Berlin, Germany.
Journal of Pediatric Surgery
|April 23, 2022
Summary
Higher hospital volume may reduce in-hospital mortality for newborns with gastroschisis. Evidence for other outcomes and surgeon volume is uncertain, requiring cautious interpretation of current findings.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Health Services Research
Background:
- Gastroschisis necessitates surgical intervention in newborns to manage intestinal exteriorization and abdominal wall closure.
- Existing volume-outcome relationships in other high-risk procedures prompted an investigation into hospital and surgeon volume for gastroschisis outcomes.
Approach:
- A systematic literature search was performed across major databases (Medline, Embase, CENTRAL, CINAHL, Biosis Previews) in June 2021.
- Included studies were (cluster-)randomized controlled trials and prospective or retrospective cohort studies examining volume-outcome relationships.
- Risk of bias was assessed using ROBINS-I, followed by systematic synthesis and GRADE assessment of evidence certainty.
Key Points:
- Twelve cohort studies focused on hospital volume; no studies addressed surgeon volume.
- Higher hospital volume may be associated with reduced in-hospital mortality for neonates with gastroschisis.
- Evidence for other outcomes (morbidity, quality of life) and surgeon volume is of very low certainty, primarily due to bias and imprecision.
Conclusions:
- The current evidence suggests a potential benefit of higher hospital volume in reducing in-hospital mortality for gastroschisis.
- The heterogeneity in effect magnitude necessitates cautious interpretation of these findings.
- There is a significant lack of evidence regarding the impact of surgeon volume on gastroschisis outcomes.
