Race and outcomes in gastroschisis repair: a nationwide analysis

Song, Ye Kyung; Lopez, Omar Nunez; Mehta, Hemalkumar B.; Bohanon, Fredrick J.; Rojas‐Khalil, Yesenia; Bowen-Jallow, Kanika A.; Radhakrishnan, Ravi S.

doi:10.1016/j.jpedsurg.2017.03.004

Cited by 25 publications

(16 citation statements)

References 24 publications

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“…2 ( 9 1 . 0 1 5 1 / 8 g 0 0 5 this is consistent with a previously reported series [30,31]. The incidences of colonic atresia and small bowel atresia are almost equal, which is fits to the series of Fleet and Shah [32,33].…”

Section: Characteristics N On-surv/nsupporting

confidence: 89%

Decentralized surgery of abdominal wall defects in Germany

et al. 2020

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Purpose Neonatal surgery for abdominal wall defects is not performed in a centralized manner in Germany. The aim of this study was to investigate whether treatment for abdominal wall defects in Germany is equally effective compared to international results despite the decentralized care. Methods All newborn patients who were clients of the major statutory health insurance company in Germany between 2009 and 2013 and who had a diagnosis of gastroschisis or omphalocele were included. Mortality during the first year of life was analysed. Results The 316 patients with gastroschisis were classified as simple (82%) or complex (18%) cases. The main associated anomalies in the 197 patients with omphalocele were trisomy 18/21 (8%), cardiac anomalies (32%) and anomalies of the urinary tract (10%). Overall mortality was 4% for gastroschisis and 16% for omphalocele. Significant factors for non-survival were birth weight below 1500 g for both groups, complex gastroschisis, volvulus and anomalies of the blood supply to the intestine in gastroschisis, and female gender, trisomy 18/21 and lung hypoplasia in omphalocele. Conclusions Despite the fact that paediatric surgical care is organized in a decentralized manner in Germany, the mortality rates for gastroschisis and omphalocele are equal to those reported in international data.

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Section: Characteristics N On-surv/nsupporting

confidence: 89%

Decentralized surgery of abdominal wall defects in Germany

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…Health disparities are the result of complex, multilevel, dynamic factors, including biological, environmental, and social elements [20]. Recent pediatric surgical literature has identified racial disparities in pediatric surgical outcomes, even after controlling for established patient- and hospital-related factors [20]. Stone et al, when evaluating postoperative morbidity, mortality, and resource utilization in several pediatric surgeries identified risk-adjusted associations of race with poorer outcomes and higher resource utilization [39].…”

Section: Discussionmentioning

confidence: 99%

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Impact of maternal education on the outcome of newborns requiring surgery for congenital malformations

et al. 2019

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Objective Numerous studies established a link between socioeconomic status (SES) and several dimensions of general health. This study examines the association between maternal education as a widely used indicator of SES and outcome in newborns requiring surgical correction of congenital anomalies. Methods Ambispective data analysis of newborns with esophageal atresia (EA), intestinal atresia (IA), congenital diaphragmatic hernia (CDH), omphalocele (OC), gastroschisis (GS) undergoing surgery between 01/2008-11/2017 accessing the clinical databases Neodat and Viewpoint. Maternal education was determined according to the validated education classification CASMIN and stratified into “low” SES and “high” SES group. Endpoints were incidence of postoperative complications, length of mechanical ventilation, and readmission to NICU. Results Inclusion of 169 patients with EA (n = 32), IA (n = 24), CDH (n = 47), OC (n = 19), GS (n = 47). Women of low SES (n = 67, 40%) attended fewer prenatal screenings (total, 4.6 vs. 7.9, P<0.0001; EA, 3.7 vs. 7.1, P = 0.0002; IA, 3.5 vs. 9.4, P = 0.0006; OC, 2.5 vs. 8.8, P = 0.009; GS, 4.1 vs. 7.0, P = 0.002). Low SES was associated with higher incidence of patients born small for gestational age (37% vs. 20%, P = 0.019), with additional congenital malformations (37% vs. 15%, P = 0.001), being born in a peripheral center (7% vs. 0%, P = 0.008), and with higher incidence of 5´APGAR scores <7 (23% vs. 7%, P = 0.004). Moreover, low SES was associated with higher incidence of postoperative complications (total 70% vs. 32%, P<0.0001; EA, 60% vs. 23%, P = 0.04; IA, 67% vs. 11%, P = 0.008; CDH, 83% vs. 46%, P = 0.009; GS, 74% vs. 25%, P = 0.001), and higher readmission rate to NICU (IA, 33% vs. 0%, P = 0.043; GS, 32% vs. 4%, P = 0.007). Conclusions Low maternal education is associated with a reduced uptake of prenatal screenings, adverse neonatal outcomes, and higher incidence of postoperative complications in newborns with congenital anomalies. Primary prevention and specific support should be provided prenatally for families with low SES to avoid adverse outcomes.

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“…Global variations in incidence have been reported, with 10.9 per 10,000 [ 10 ] in Greenland and 29.9 per 10,000 in Mexico [ 11 ]. Ethnic variations in incidence [ 9 , 12 ] and evidence of regional or geospatial clustering have also been described [ 13 , 14 ]. Controversy and conflicting reports have existed about the influence of terminations [ 15 ] and misdiagnosis or incomplete data capture [ 16 ] on reporting of the incidence of gastroschisis.…”

Section: Introductionmentioning

confidence: 99%

Complexity of gastroschisis predicts outcome: epidemiology and experience in an Australian tertiary centre

Melov

Tsang

Cohen

et al. 2018

BMC Pregnancy Childbirth

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BackgroundGastroschisis is a congenital anomaly of the fetal abdominal wall, usually to the right side of umbilical insertion. It is often detected by routine antenatal ultrasound. Significant maternal and pediatric resources are utilised in the care of women and infants with gastroschisis. Increasing rates of gastroschisis worldwide have led institutions to review local data and investigate outcomes. A collaborative project was developed to review local epidemiology and investigate antenatal and neonatal factors influencing hospital length of stay (LOS) and total parental nutrition (TPN) in infants born with gastroschisis.MethodsWe performed a five-year review of infants born with gastroschisis (2011–2015) at a major Australian centre. Complex gastroschisis was defined as involvement of stenosis, atresia, ischemia, volvulus or perforation and closed or vanishing gastroschisis. We extracted data from files and databases at the two participating hospitals, a major maternal fetal medicine centre and the affiliated children’s hospital.ResultsThere were 56 infants antenatally diagnosed with gastroschisis with no terminations, one stillbirth (2%) and one infant with ‘vanishing’ gastroschisis. The mean maternal age was 23.9 years (range, 15–39 years). The mean gestation at delivery was 36 weeks (range, 25–39+ 3 weeks). Of the 55 neonates who received surgical management, 62% had primary closure. The median LOS was 33 (IQR, 23–45) days and the median duration of TPN was 26 (IQR, 17–36) days. Longer days on TPN (median 35 vs 16 days, P = 0.03) was associated with antenatal finding of multiple dilated bowel loops. Postnatal diagnosis of complex gastroschisis was made in 16% of cases and was associated with both longer LOS (median 89 vs 30 days, P = 0.003) and days on TPN (median 46 vs 21 days, P = 0.009).ConclusionComplex gastroschisis was associated with greater days on TPN and LOS. We found no late-gestation stillbirths and a low overall rate of 1.8%, suggesting the risk for stillbirth associated with gastroschisis is lower than previously documented. This information may assist counselling families. Improved data collection worldwide may reveal causative factors and enable antenatal outcome predictors.

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Race and outcomes in gastroschisis repair: a nationwide analysis

Abstract: Level of Evidence: II.

Cited by 25 publications

References 24 publications

Decentralized surgery of abdominal wall defects in Germany

Decentralized surgery of abdominal wall defects in Germany

Impact of maternal education on the outcome of newborns requiring surgery for congenital malformations

Complexity of gastroschisis predicts outcome: epidemiology and experience in an Australian tertiary centre

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