title: The association of type of surgical closure on length of stay among infants with gastroschisis born≥34 weeks' gestation.
abstract: OBJECTIVE
  The optimal surgical approach in infants with gastroschisis (GS) is unknown. The purpose of this study was to estimate the association between staged closure and length of stay (LOS) in infants with GS.
  
  
  METHODS
  We used the Children's Hospital Neonatal Database to identify surviving infants with GS born ≥34 weeks' gestation referred to participating NICUs. Infants with complex GS, bowel atresia, or referred after 2 days of age were excluded. The primary outcome was LOS; multivariable linear regression was used to quantify the relationship between staged closure and LOS.
  
  
  RESULTS
  Among 442 eligible infants, staged closure occurred in 68.1% and was associated with an increased median LOS relative to odds ration (OR):primary closure (37 vs. 28 days, p<0.001). This association persisted in the multivariable equation (β=1.35, 95% CI: 1.21, 1.52, p<0.001) after adjusting for the presence of necrotizing enterocolitis, short bowel syndrome, and central-line associated bloodstream infections.
  
  
  CONCLUSIONS
  In this large, multicenter cohort of infants with GS, staged closure was independently associated with increased LOS. These data can be used to enhance antenatal and pre-operative counseling and also suggest that some infants who receive staged closure may benefit from primary repair.
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address: k-murthy@northwestern.edu.
authors.forename: Karna
authors.initials: K
authors.lastname: Murthy
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jacquelyn R
authors.initials: JR
authors.lastname: Evans
authors.affiliation: Children's Healthcare of Atlanta at Egleston, Egleston, GA, USA; Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Amina M
authors.initials: AM
authors.lastname: Bhatia
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Rothstein
authors.affiliation: Florida Hospital for Children, Center for Neonatal Care, Orlando, FL, USA; Department of Pediatrics, University of Central Florida School of Medicine, Orlando, FL, USA.
authors.forename: Rajan
authors.initials: R
authors.lastname: Wadhawan
authors.affiliation: Children's Hospital Association, Overland Park, KS, USA.
authors.forename: Isabella
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Washington University School of Medicine in St. Louis, St. Louis, MO, USA; St. Louis Children's Hospital, Department of Pediatrics, St Louis, MO, USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Rao
authors.affiliation: Children's Hospital Association, Overland Park, KS, USA.
authors.forename: Cary
authors.initials: C
authors.lastname: Thurm
authors.affiliation: Washington University School of Medicine in St. Louis, St. Louis, MO, USA; St. Louis Children's Hospital, Department of Pediatrics, St Louis, MO, USA.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Mathur
authors.affiliation: Children's Healthcare of Atlanta at Egleston, Egleston, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Piazza
authors.affiliation: Children's Hospital Los Angeles, Department of Surgery, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Stein
authors.affiliation: Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, USA.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Reber
authors.affiliation: Children's National Health System, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Billie Lou
authors.initials: BL
authors.lastname: Short
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Padula
authors.affiliation: Children's Hospital Research Center, Oakland, CA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA.
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Asselin
authors.affiliation: Children's Mercy, Kansas City, MO, USA; Department of Pediatrics, University of Missouri School of Medicine, Kansas City, MO, USA.
authors.forename: Eugenia K
authors.initials: EK
authors.lastname: Pallotto
authors.affiliation: Children's Healthcare of Atlanta at Egleston, Egleston, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Francine D
authors.initials: FD
authors.lastname: Dykes
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000639:trends; D008297:Male; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Children's Hospitals Neonatal Consortium; Children’s Hospital Neonatal Database (CHND); Gastroschisis; Infant; Length of stay; Neonatal intensive care; Staged closure