Decreasing Length of Stay for Simple Gastroschisis: Analysis of the National Surgical Quality Improvement Program (NSQIP)

Abstract

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.