title: The Influence of Infectious Complications in Gastroschisis on Costs and Length of Stay.
abstract: ObjectiveOutcomes for gastroschisis (GS) remain highly variable and avoiding infectious complications (ICs) may represent a significant improvement opportunity. Our objective was to provide estimates of the impact of IC on length of stay (LOS) and costs.Study DesignUsing a national database, 1,378 patients with GS were identified. Patient and hospital characteristics were compared and LOS and costs evaluated for patients with and without IC.ResultsTwo-thirds of all GS patients had IC, and IC were common for simple and complex GS (65, 73%, respectively). After controlling for patient and hospital factors, LOS in patients with IC was significantly longer than in patients without IC (4.5-day increase,p= 0.001). Specifically, sepsis was associated with increasing median LOS by 11 days (p≤ 0.001), candida infection by 14 days (p< 0.001), and wound infection by 7 days (p= 0.007). Although overall costs did not differ between patients with and without IC, costs were elevated based on specific IC. Sepsis increased median costs by $22,380 (95% confidence interval [CI]: $14,372-30,388;p≤ 0.001), wound infection by $32,351 (95% CI: $17,221-47,481;p≤ 0.001), catheter-related infection by $57,180 (95% CI: $12,834-101,527;p= 0.011), and candida infections by $24,500 (95% CI: $8,832-40,167;p= 0.002).ConclusionIC among GS patients are common and contribute to increased LOS and costs. Quantifying clinical and financial ramifications of IC may help direct future quality improvement efforts.
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Monika
authors.initials: M
authors.lastname: Uribe-Leitz
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: McCracken
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Kurt F
authors.initials: KF
authors.lastname: Heiss
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wulkan
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
mesh_terms: D002177:Candidiasis / Q000191:economics / Q000453:epidemiology*; D016208:Databases, Factual; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000191:economics / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology*