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Am J Perinatol 2017; 34(01): 62-69
DOI: 10.1055/s-0036-1584299
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Influence of Infectious Complications in Gastroschisis on Costs and Length of Stay

Monika Uribe-Leitz
1   Rollins School of Public Health, Emory University, Atlanta, Georgia
,
Courtney E. McCracken
2   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
,
Kurt F. Heiss
3   Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
,
Mark L. Wulkan
3   Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
,
Mehul V. Raval
3   Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

11 January 2016

27 April 2016

Publication Date:
30 May 2016 (online)

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Abstract

Objective Outcomes 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 Design Using 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.

Results Two-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).

Conclusion IC 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.

Keywords

gastroschisis - costs - length of stay - infections - quality improvement

Supplementary Material

 

  • References

  • 1 Eichenwald EC, Stark AR. Management and outcomes of very low birth weight. N Engl J Med 2008; 358 (16) 1700-1711
    CrossrefPubMedGoogle Scholar
  • 2 Muraskas J, Parsi K. The Cost of Saving the Tiniest Lives: NICUs versus Prevention. Virtual Mentor 2008; 10 (10) 655-658
    CrossrefPubMedGoogle Scholar
  • 3 Catlin A. Extremely long hospitalizations of newborns in the United States: data, descriptions, dilemmas. Adv Neonatal Care 2008; 8 (2) 125-132
    CrossrefPubMedGoogle Scholar
  • 4 Bucher BT, Mazotas IG, Warner BW, Saito JM. Effect of time to surgical evaluation on the outcomes of infants with gastroschisis. J Pediatr Surg 2012; 47 (6) 1105-1110
    CrossrefPubMedGoogle Scholar
  • 5 Mastroiacovo P, Lisi A, Castilla EE. The incidence of gastroschisis: research urgently needs resources. BMJ 2006; 332 (7538) 423-424
    CrossrefPubMedGoogle Scholar
  • 6 Langlois PH, Marengo LK, Canfield MA. Time trends in the prevalence of birth defects in Texas 1999-2007: real or artifactual?. Birth Defects Res A Clin Mol Teratol 2011; 91 (10) 902-917
    CrossrefPubMedGoogle Scholar
  • 7 Lao OB, Larison C, Garrison MM, Waldhausen JH, Goldin AB. Outcomes in neonates with gastroschisis in U.S. children's hospitals. Am J Perinatol 2010; 27 (1) 97-101
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Pastor AC, Phillips JD, Fenton SJ , et al. Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial. J Pediatr Surg 2008; 43 (10) 1807-1812
    CrossrefPubMedGoogle Scholar
  • 9 Phillips JD, Raval MV, Redden C, Weiner TM. Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity. J Pediatr Surg 2008; 43 (12) 2208-2212
    CrossrefPubMedGoogle Scholar
  • 10 Khalil BA, Baath ME, Baillie CT , et al. Infections in gastroschisis: organisms and factors. Pediatr Surg Int 2008; 24 (9) 1031-1035
    CrossrefPubMedGoogle Scholar
  • 11 Driver CP, Bruce J, Bianchi A, Doig CM, Dickson AP, Bowen J. The contemporary outcome of gastroschisis. J Pediatr Surg 2000; 35 (12) 1719-1723
    Google Scholar
  • 12 National (Nationwide) HCUP Databases. Healthcare cost and utilization project (HCUP). 2012. Available at: https://www.hcup-us.ahrq.gov/databases.jsp . Accessed May 20, 2016
    PubMedGoogle Scholar
  • 13 Molik KA, Gingalewski CA, West KW , et al. Gastroschisis: a plea for risk categorization. J Pediatr Surg 2001; 36 (1) 51-55
    CrossrefPubMedGoogle Scholar
  • 14 Iwashyna TJ, Odden A, Rohde J , et al. Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis. Med Care 2014; 52 (6) e39-e43
    CrossrefPubMedGoogle Scholar
  • 15 Decembrino L, Perrini S, Stronati M. [Surveillance of infection events in neonatal intensive care]. Minerva Pediatr 2010; 62 (3) (Suppl. 01) 41-45
    PubMedGoogle Scholar
  • 16 Anderson JE, Chang DC. Using electronic health records for surgical quality improvement in the era of big data. JAMA Surg 2015; 150 (1) 24-29
    CrossrefPubMedGoogle Scholar
  • 17 Hook-Dufresne DM, Yu X, Bandla V, Imseis E, Moore-Olufemi SD. The economic burden of gastroschisis: costs of a birth defect. J Surg Res 2015; 195 (1) 16-20
    CrossrefPubMedGoogle Scholar
  • 18 Sydorak RM, Nijagal A, Sbragia L , et al. Gastroschisis: small hole, big cost. J Pediatr Surg 2002; 37 (12) 1669-1672
    CrossrefPubMedGoogle Scholar
  • 19 Aljahdali A, Mohajerani N, Skarsgard ED ; Canadian Pediatric Surgery Network (CAPSNet). Effect of timing of enteral feeding on outcome in gastroschisis. J Pediatr Surg 2013; 48 (5) 971-976
    Google Scholar
  • 20 Lemoine JB, Smith RR, White D. Got milk? Effects of early enteral feedings in patients with gastroschisis. Adv Neonatal Care 2015; 15 (3) 166-175
    CrossrefPubMedGoogle Scholar
  • 21 Ţarcă E, Ciongradi I, Aprodu SG ; -. Birth Weight, Compromised Bowel and Sepsis are the Main Variables Significantly Influencing Outcome in Gastroschisis. Chirurgia (Bucur) 2015; 110 (2) 151-156
    PubMedGoogle Scholar
  • 22 Larson E. Skin hygiene and infection prevention: more of the same or different approaches?. Clin Infect Dis 1999; 29 (5) 1287-1294
    CrossrefPubMedGoogle Scholar
  • 23 Neill S, Haithcock S, Smith PB , et al. Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit. Adv Neonatal Care 2016; 16 (1) 52-59
    CrossrefPubMedGoogle Scholar
  • 24 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
    CrossrefPubMedGoogle Scholar
  • 25 Kaplan HC, Lannon C, Walsh MC, Donovan EF ; Ohio Perinatal Quality Collaborative. Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants. Pediatrics 2011; 127 (3) 427-435
    CrossrefPubMedGoogle Scholar
  • 26 Resende DS, Peppe AL, dos Reis H, Abdallah VO, Ribas RM, Gontijo Filho PP. Late onset sepsis in newborn babies: epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit. Braz J Infect Dis 2015; 19 (1) 52-57
    CrossrefPubMedGoogle Scholar
  • 27 Fisher D, Cochran KM, Provost LP , et al. Reducing central line-associated bloodstream infections in North Carolina NICUs. Pediatrics 2013; 132 (6) e1664-e1671
    CrossrefPubMedGoogle Scholar
  • 28 Aliaga S, Clark RH, Laughon M , et al. Changes in the incidence of candidiasis in neonatal intensive care units. Pediatrics 2014; 133 (2) 236-242
    CrossrefPubMedGoogle Scholar
  • 29 Wang KS ; Committee on Fetus and Newborn, American Academy of Pediatrics; Section on Surgery, American Academy of Pediatrics. Assessment and management of inguinal hernia in infants. Pediatrics 2012; 130 (4) 768-773
    CrossrefPubMedGoogle Scholar
  • 30 Lee SL, Gleason JM, Sydorak RM. A critical review of premature infants with inguinal hernias: optimal timing of repair, incarceration risk, and postoperative apnea. J Pediatr Surg 2011; 46 (1) 217-220
    CrossrefPubMedGoogle Scholar
  • 31 Duggan EM, Patel VP, Blakely ML. Inguinal hernia repair in premature infants: more questions than answers. Arch Dis Child Fetal Neonatal Ed 2015; 100 (4) F286-F288
    CrossrefPubMedGoogle Scholar
  • 32 Antonoff MB, Kreykes NS, Saltzman DA, Acton RD. American Academy of Pediatrics Section on Surgery hernia survey revisited. J Pediatr Surg 2005; 40 (6) 1009-1014
    CrossrefPubMedGoogle Scholar
  • 33 Lawson EH, Louie R, Zingmond DS , et al. A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg 2012; 256 (6) 973-981
    CrossrefPubMedGoogle Scholar
  • 34 Raval MV, Dillon PW, Bruny JL , et al; ACS NSQIP Pediatric Steering Committee. Pediatric American College of Surgeons National Surgical Quality Improvement Program: feasibility of a novel, prospective assessment of surgical outcomes. J Pediatr Surg 2011; 46 (1) 115-121
    CrossrefPubMedGoogle Scholar