title: Improving gastroschisis outcomes: does birth place matter?
abstract: OBJECTIVE
  Babies born in the hospital where they obtain definitive surgical care do not require transportation between institutions and may have shorter time to surgical intervention. Whether these differences result in meaningful improvement in outcomes has been debated. A multi-institutional retrospective study was performed comparing outcomes based on birthplace.
  
  
  METHODS
  Six institutions within the PedSRC reviewed infants born with gastroschisis from 2008 to 2013. Birthplace, perinatal, and postoperative data were collected. Based on the P-NSQIP definition, inborn was defined as birth at the pediatric hospital where repair occurred. The primary outcome was days to full enteral nutrition (FEN; 120kcal/kg/day).
  
  
  RESULTS
  528 patients with gastroschisis were identified: 286 inborn, 242 outborn. Days to FEN, time to bowel coverage and abdominal wall closure, primary closure rate, and length of stay significantly favored inborn patients. In multivariable analysis, birthplace was not a significant predictor of time to FEN. Gestational age, presence of atresia or necrosis, primary closure rate, and time to abdominal wall closure were significant predictors.
  
  
  CONCLUSIONS
  Inborn patients had bowel coverage and definitive closure sooner with fewer days to full feeds and shorter length of stay. Birthplace appears to be important and should be considered in efforts to improve outcomes in patients with gastroschisis.
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: ksavoie@uthsc.edu.
authors.forename: Kate B
authors.initials: KB
authors.lastname: Savoie
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: ehuang@uthsc.edu.
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
authors.affiliation: University of Texas at Houston, Houston, Texas. Electronic address: shahroz.k.aziz@uth.tmc.edu.
authors.forename: Shahroz K
authors.initials: SK
authors.lastname: Aziz
authors.affiliation: Vanderbilt University, Nashville, Tennessee. Electronic address: martin.blakely@vanderbilt.edu.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.affiliation: University of Arkansas, Little Rock, Arkansas. Electronic address: dassingermelvins@uams.edu.
authors.forename: Sid
authors.initials: S
authors.lastname: Dassinger
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: adorale@iupui.edu.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Dorale
authors.affiliation: Vanderbilt University, Nashville, Tennessee. Electronic address: eileen.m.duggan@vanderbilt.edu.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Duggan
authors.affiliation: University of Texas at Houston, Houston, Texas. Electronic address: matthew.t.harting@uth.tmc.edu.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Harting
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: tmarkel@iupui.edu.
authors.forename: Troy A
authors.initials: TA
authors.lastname: Markel
authors.affiliation: University of Texas at Houston, Houston, Texas. Electronic address: stacey.d.moore-olufemi@uth.tmc.edu.
authors.forename: Stacey D
authors.initials: SD
authors.lastname: Moore-Olufemi
authors.affiliation: University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: sshah@cmh.edu.
authors.forename: Sohail R
authors.initials: SR
authors.lastname: Shah
authors.affiliation: University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: sspeter@cmh.edu.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: University of Texas at Houston, Houston, Texas. Electronic address: koujen.tsao@uth.tmc.edu.
authors.forename: Koujen
authors.initials: K
authors.lastname: Tsao
authors.affiliation: University of Arkansas, Little Rock, Arkansas. Electronic address: dlwyrick@uams.edu.
authors.forename: Deidre L
authors.initials: DL
authors.lastname: Wyrick
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: rfwillia@uthsc.edu.
authors.forename: Regan F
authors.initials: RF
authors.lastname: Williams
mesh_terms: D005260:Female; D015391:Gastroplasty; D020139:Gastroschisis / Q000453:epidemiology / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Birth location; Birthplace; Gastroschisis; Outcomes; Regionalization