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Published on: December 31, 2015
Inter-center variations in inpatient outcomes for infants with gastroschisis from the Children's Hospitals Neonatal
Con Yee Ling1, Isabella Zaniletti2, Stefanie Riddle3
1Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA. conyee.ling@hsc.utah.edu.
Insights
Hospital care significantly impacts outcomes for infants with gastroschisis, affecting length of stay (LOS) and oral feeding at discharge. These variations highlight differences in management strategies across treatment centers.
Area of Science:
- Neonatal Surgery
- Pediatric Gastroenterology
- Healthcare Quality Improvement
Background:
- Gastroschisis is a congenital abdominal wall defect requiring complex neonatal surgical and medical management.
- Variations in care pathways may influence patient outcomes, including hospital length of stay (LOS) and feeding progression.
Purpose of the Study:
- To quantify inter-center variation (ICV) in hospital length of stay (LOS) for infants with gastroschisis.
- To assess ICV in the rate of discharge with exclusive oral feeding among infants with gastroschisis.
Main Methods:
- Utilized the Children's Hospitals Neonatal Consortium (CHNC) database to identify hospitalized survivors with gastroschisis.
- Employed generalized linear models and logistic regression to analyze LOS and oral feeding at discharge, respectively.
- Performed unadjusted and adjusted analyses to account for potential confounders.
Main Results:
- Significant inter-center variation was observed in both LOS and discharge with exclusive oral feeding for 3987 infants.
- Risk-adjusted LOS showed a 68% difference between centers.
- Oral feeding at discharge varied 6.4-fold between centers, even after multivariable adjustment.
Conclusions:
- Hospital of care is an independent factor associated with LOS and oral feeding outcomes in gastroschisis survivors.
- Disparities in management strategies, possibly influenced by parental preferences, likely contribute to the observed inter-center variation.
Objective:
To estimate inter-center variation (ICV) in hospital length of stay (LOS) and oral feeding at discharge among infants with gastroschisis.
Study Design:
The Children's Hospitals Neonatal Consortium's (CHNC) database was used to identify hospitalized survivors with gastroschisis. Two outcomes were evaluated: LOS and discharge without tube feedings. Hospital outcomes were evaluated in unadjusted and adjusted analyses. Generalized linear models with log link for gamma distribution were used to model LOS and logistic regression for discharge without tube feeds.
Results:
For 3987 surviving infants with gastroschisis, LOS and discharge within 70 days with exclusively oral feeding both exhibited significant ICV. Differences persisted in multivariable analyses. Risk-adjusted LOS (68% difference) and oral feeding at discharge (6.4-fold difference) varied significantly between centers.
Conclusion:
Hospital of care was independently associated with LOS and exclusive oral feeding at discharge rates for infants with gastroschisis. Management differences, potentially influenced by parental preferences, contributed to variation.
