Outcomes of Gastroschisis and Omphalocele Treated at Children’s Surgery Verified Centers in Texas

Abstract

Introduction

Anterior abdominal wall defects (AWDs), such as gastroschisis or omphalocele, are often diagnosed prenatally and counseled to deliver at facilities with resources capable of managing their AWD and complex-associated anomalies. The American College of Surgeons instituted their Children’s Surgery Verification (CSV) program to identify facilities with the optimal resources for pediatric surgical care. We aimed to evaluate the impact of CSV status on the outcomes of AWD and potential health disparities in the care of AWD in the first year of life in Texas.

Materials and Methods

We performed a multicenter epidemiological cohort study of infants <1 y of age at discharge with AWD from 2013 to 2021. Data were extracted from the Texas Health Care Information Council Public Use Data File. Patients who were transferred were excluded to avoid systematic double counting.

Results

We identified 2282 AWD patients with 26% treated at CSV centers and 68% undergoing surgical abdominal wall repair. The majority (70%) had gastroschisis. CSV center care recipients were more likely to be non-Hispanic (64% versus 58%, P = 0.018), reside in urban counties (92% versus 82%, P < 0.001), or counties not along the Mexican border (98% versus 81%, P < 0.001) when compared with non-CSV patients. While non-CSV admissions had lower costs per day ($9316 versus $10,109, P = 0.003), CSV centers had slightly lower mortality although this was not statistically significant (8% versus 10%, P = 0.153) despite higher illness severity scores (extreme illness severity: 51% versus 44%, P = 0.019). However, it is notable that non-CSV centers had higher rates of prematurity (62% versus 55%, P = 0.003). Multivariable logistic regression analysis for mortality revealed that treatment at CSV centers (adjusted odds ratio 0.562, P = 0.005) was protective. Predictive modeling revealed that CSV centers have lower predicted mortality across all illness severity levels as compared with non-CSV centers.

Conclusions

AWD treated at CSV centers have superior outcomes with improved mortality despite increased patient complexity and illness severity. Disparities in care at CSV centers exist based on race and geographic residency. Ongoing quality efforts are needed to improve quality universally and recognize facilities providing high-quality care while also ensuring equitable access to high-quality pediatric surgical care.