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Does time to theater matter in simple gastroschisis?

OBJECTIVE: A recent publication has suggested that expedited time to theater in gastroschisis results in higher rates of primary closure and decreases the length of stay (LOS). This study primarily aims to assess the impact of time to first management of neonates with gastroschisis on the LOS. METHO...

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Autores principales: O'Shea, Kathryn, Harwood, Rachel, O’Donnell, Sean, Baillie, Colin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476109/
https://www.ncbi.nlm.nih.gov/pubmed/37671120
http://dx.doi.org/10.1136/wjps-2023-000575
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author O'Shea, Kathryn
Harwood, Rachel
O’Donnell, Sean
Baillie, Colin
author_facet O'Shea, Kathryn
Harwood, Rachel
O’Donnell, Sean
Baillie, Colin
author_sort O'Shea, Kathryn
collection PubMed
description OBJECTIVE: A recent publication has suggested that expedited time to theater in gastroschisis results in higher rates of primary closure and decreases the length of stay (LOS). This study primarily aims to assess the impact of time to first management of neonates with gastroschisis on the LOS. METHODS: Neonates admitted between August 2013 and August 2020 with gastroschisis were included. Data were collected retrospectively, and neonates with complex gastroschisis were excluded. Variables including gestation, birth weight, time of first management, primary/delayed closure and use of patch were evaluated as possible confounding variables. The outcome measures were time to full feeds, time on parenteral nutrition (PN) and LOS. Univariate and multivariate linear regression analyses were performed. P<0.05 was regarded as significant. RESULTS: Eighty-six neonates were identified, and 16 were then excluded (eight patients with complex gastroschisis, eight patients with time to first management not documented). The median LOS for those who underwent primary closure was 21 days (interquartile range (IQR) =16–29) and for those who underwent silo placement and delayed closure was 59 days (IQR=44–130). The mean time to first management was 473 min (standard deviation (SD) =146 min), with only 20% of these infants being operated on at less than 6 hours of age. Univariate and multivariate analyses demonstrated no relationship between time to first management and LOS (r(2)=0.00, p=0.82) but did demonstrate a consistent positive association between time to first feed and LOS and delayed closure, resulting in a longer time to full feeds and a longer time on PN. CONCLUSIONS: The time to first management was not associated with a change in LOS in these data. Further prospective evaluation of the impact of reducing the time to first feed on the LOS is recommended. LEVEL OF EVIDENCE: IV.
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spelling pubmed-104761092023-09-05 Does time to theater matter in simple gastroschisis? O'Shea, Kathryn Harwood, Rachel O’Donnell, Sean Baillie, Colin World J Pediatr Surg Original Research OBJECTIVE: A recent publication has suggested that expedited time to theater in gastroschisis results in higher rates of primary closure and decreases the length of stay (LOS). This study primarily aims to assess the impact of time to first management of neonates with gastroschisis on the LOS. METHODS: Neonates admitted between August 2013 and August 2020 with gastroschisis were included. Data were collected retrospectively, and neonates with complex gastroschisis were excluded. Variables including gestation, birth weight, time of first management, primary/delayed closure and use of patch were evaluated as possible confounding variables. The outcome measures were time to full feeds, time on parenteral nutrition (PN) and LOS. Univariate and multivariate linear regression analyses were performed. P<0.05 was regarded as significant. RESULTS: Eighty-six neonates were identified, and 16 were then excluded (eight patients with complex gastroschisis, eight patients with time to first management not documented). The median LOS for those who underwent primary closure was 21 days (interquartile range (IQR) =16–29) and for those who underwent silo placement and delayed closure was 59 days (IQR=44–130). The mean time to first management was 473 min (standard deviation (SD) =146 min), with only 20% of these infants being operated on at less than 6 hours of age. Univariate and multivariate analyses demonstrated no relationship between time to first management and LOS (r(2)=0.00, p=0.82) but did demonstrate a consistent positive association between time to first feed and LOS and delayed closure, resulting in a longer time to full feeds and a longer time on PN. CONCLUSIONS: The time to first management was not associated with a change in LOS in these data. Further prospective evaluation of the impact of reducing the time to first feed on the LOS is recommended. LEVEL OF EVIDENCE: IV. BMJ Publishing Group 2023-08-31 /pmc/articles/PMC10476109/ /pubmed/37671120 http://dx.doi.org/10.1136/wjps-2023-000575 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
O'Shea, Kathryn
Harwood, Rachel
O’Donnell, Sean
Baillie, Colin
Does time to theater matter in simple gastroschisis?
title Does time to theater matter in simple gastroschisis?
title_full Does time to theater matter in simple gastroschisis?
title_fullStr Does time to theater matter in simple gastroschisis?
title_full_unstemmed Does time to theater matter in simple gastroschisis?
title_short Does time to theater matter in simple gastroschisis?
title_sort does time to theater matter in simple gastroschisis?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476109/
https://www.ncbi.nlm.nih.gov/pubmed/37671120
http://dx.doi.org/10.1136/wjps-2023-000575
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