Practice variation in gastroschisis: factors influencing closure technique.
BACKGROUND
Little is known about the factors influencing surgical practice variation in newborns with gastroschisis. The purpose of this study was to correlate prognostic variables with the intended and actual abdominal closure technique and assess related outcomes.


METHODS
GS cases were abstracted from a national database. Variables evaluated included GA, BW, bowel injury severity (GPS), neonatal illness severity (SNAP-II), inborn status, center volume and training status, and admission time. Evaluated outcomes by closure method included duration of TPN, LOS, and complications. Descriptive, univariate and multivariable regression analyses were conducted.


RESULTS
The cohort consisted of 679 patients. A total of 372 (55%) underwent attempted PR, of which 300 (81%) were successful, while 307 (45%) had a silo placed intentionally. Patients undergoing attempted PR were more likely to be inborn, have daytime admissions, and higher SNAP-II scores. Successful PR was predicted by low risk GPS and high volume center. With the exception of higher rates of SSI in the planned silo group, outcomes in the successful PR and planned silo groups were comparable.


CONCLUSIONS
Practice variation related to type of closure is predicted by situational and institutional factors (outborn, nighttime admission, and center volume), while outcome variation is attributable to patient factors rather than practice variation.
Division of Pediatric Surgery, Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Jennifer
J
Stanger
Division of Pediatric Surgery, Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Noosheen
N
Mohajerani
Division of Pediatric Surgery, Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada. Electronic address: eskarsgard@cw.bc.ca.
Erik D
ED
Skarsgard
D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010289:Parenteral Nutrition, Total; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial; D018570:Risk Assessment; D013530:Surgical Wound Infection; D016896:Treatment Outcome
Gastroschisis; Practice variation; Risk-adjusted outcome variation; Surgical management