title: Multi-institutional practice patterns and outcomes in uncomplicated gastroschisis: a report from the University of California Fetal Consortium (UCfC).
abstract: OBJECTIVE
  Gastroschisis is a resource-intensive birth defect without consensus regarding optimal surgical and medical management. We sought to determine best-practice guidelines by examining differences in multi-institutional practices and outcomes.
  
  
  METHODS
  Site-specific practice patterns were queried, and infant-maternal chart review was retrospectively performed for gastroschisis infants treated at 5 UCfC institutions (2007-2012). The primary outcome was length of stay. Univariate analysis was done to assess variation practices and outcomes by site. Multivariate models were constructed with site as an instrumental variable and with sites grouped by silo practice pattern adjusting for confounding factors.
  
  
  RESULTS
  Of 191 gastroschisis infants, 164 infants were uncomplicated. Among uncomplicated patients, there were no deaths and only one case of necrotizing enterocolitis. Bivariate analysis revealed significant differences in practices and outcomes by site. Despite wide variations in practice patterns, there were no major differences in outcome among sites or by silo practice, after adjusting for confounding factors.
  
  
  CONCLUSIONS
  Wide variability exists in institutional practice patterns for infants with gastroschisis, but poor outcomes were not associated with expeditious silo or primary closure, avoidance of routine paralysis, or limited central line and antibiotic durations. Development of clinical pathways incorporating these practices may help standardize care and reduce health care costs.
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, San Francisco. Electronic address: luskl@peds.ucsf.edu.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Lusk
authors.affiliation: Department of Surgery, Division of Neonatology, University of California, Davis. Electronic address: erin.brown@ucdmc.ucdavis.edu.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Brown
authors.affiliation: Department of Reproductive Medicine, Division of Maternal-Fetal Medicine, University of California, San Diego. Electronic address: rovercash@ucsd.edu.
authors.forename: Rachael T
authors.initials: RT
authors.lastname: Overcash
authors.affiliation: Department of Medicine, Division of Health Services Research, University of California, Los Angeles. Electronic address: tgrogan@mednet.ucla.edu.
authors.forename: Tristan R
authors.initials: TR
authors.lastname: Grogan
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, San Francisco. Electronic address: kellerr@peds.ucsf.edu.
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, San Diego. Electronic address: neojae@ucsd.edu.
authors.forename: Jae H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, Davis. Electronic address: francis.poulain@ucdmc.ucdavis.edu.
authors.forename: Francis R
authors.initials: FR
authors.lastname: Poulain
authors.affiliation: Department of Surgery, University of California, Los Angeles. Electronic address: sshew@mednet.ucla.edu.
authors.forename: Steve B
authors.initials: SB
authors.lastname: Shew
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, Irvine. Electronic address: ccuy@uci.edu.
authors.forename: Cherry
authors.initials: C
authors.lastname: Uy
authors.affiliation: Department of Surgery, University of California, Los Angeles. Electronic address: ddeugarte@mednet.ucla.edu.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: DeUgarte
mesh_terms: D002140:California; D019468:Disease Management; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D020139:Gastroschisis / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007325:Institutional Practice; D008297:Male; D012189:Retrospective Studies; D014495:Universities / Q000706:statistics & numerical data*
keywords: Gastroschisis; Outcome; Practice; Silo; Uncomplicated