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Decreasing Length of Stay for Simple Gastroschisis: Analysis of the National Surgical Quality Improvement Program
Erwin T Cabacungan1, Amy J Wagner2, Ruby Gupta1
1Section of Neonatology, Department of Pediatrics, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, United States.
Insights
Length of stay for simple gastroschisis (sGS) infants decreased significantly from 2012-2022. Higher birth weight and later gestational age are linked to shorter hospital stays, indicating improved management for gastroschisis (GS).
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Healthcare Quality Improvement
Background:
- Gastroschisis (GS) is a common infant abdominal defect with variable management and outcomes.
- Length of stay (LOS) is a key metric for surgical quality and efficiency in GS infants.
- LOS is influenced by factors like defect complexity, surgical approach, complications, and care protocols.
Purpose of the Study:
- To analyze annual trends in LOS for simple gastroschisis (sGS).
- To identify predictors influencing LOS trends in sGS infants.
- To assess changes in sGS demographics and outcomes over a decade.
Main Methods:
- Retrospective cohort study using the 2012-2022 NSQIP-Pediatrics dataset.
- Analysis of LOS trends based on year of admission.
- Inclusion of demographic, preoperative, and postoperative variables to identify predictors.
Main Results:
- Median LOS for sGS infants decreased by five days (30 to 25 days) from 2012 to 2022 (p<0.001).
- A decrease in the incidence of sGS cases was observed (0.34% to 0.16%, p<0.001).
- Factors associated with longer LOS included gestational age <36 weeks, bleeding/transfusions (HR=0.53), and nutritional support at discharge (HR=0.27).
Conclusions:
- LOS reduction in sGS infants suggests improvements linked to higher birth weight and later gestational age.
- National registry data are crucial for understanding infant outcomes.
- Variations in demographics and outcomes highlight the need for standardized care protocols for gastroschisis.
Background:
Gastroschisis (GS) is the most common abdominal defect in infants, yet lack of consensus has led to variations in its management and outcomes. Length of stay (LOS) is an important measure of surgical quality and efficiency in GS infants. LOS depends on clinical and patient-related factors such as simple (sGS) or complex (cGS), type of surgery, associated complications, and factors such as the use of standardized care protocols.
Objectives:
To determine the annual trends in LOS for sGS and identify the predictors leading to these trends.
Methods/Design:
We conducted a retrospective cohort study of infants with sGS using the 2012-2022 NSQIP-Pediatrics dataset. Predictor variable for LOS was the year of admission divided into five groups. Demographics, preoperative risk factors, and postoperative complications and outcomes were collected.
Results:
From 2012 to 2022, median LOS decreased by five days (30-25 days, p-value= <0.001). We also found that there was a decrease sGS cases in NSQIP dataset (0.34/100 to 0.16/100 infants, p-value= <0.001) was noted. There was an increasing percentage of sGS for Hispanic race, inborn, higher birthweight, and superficial incisional surgical site infection (sSSI), a trend towards increasing gestational age, but no differences in timing of surgery and unplanned readmission. Stratified Cox proportional model analysis revealed that gestational age of <36 weeks, bleeding/transfusions [Hazard Ratio (HR) = 0.53, p < 0.001] and nutritional support at discharge (HR = 0.27, p < 0.001) were associated with significantly longer LOS.
Conclusion:
The trends in LOS reduction in sGS infants point towards higher birth weight, later gestational age and more optimal management. It underscores the importance of utilizing national registry databases to better understand the outcomes. Despite these improvements, the observed variations in demographics and outcomes indicate a need for standardized care protocols and a better understanding of the factors influencing LOS.
Level Of Evidence:
Level II.
