Gastroschisis: Impact of Delivery Planning on Patient Outcomes
Corresponding AuthorBurjonrappa Sathyaprasad
University of South Florida, Tampa, FL
A B S T R A C T
Introduction: Success rates of gastroschisis interventions on outcome have been increasingly examined. Much of the work has focused on post-delivery management and timing of the final closure. Little data is available regarding the impact of the timing of fetal delivery on outcomes. This study aims to examine the relationships between overall outcomes of patients diagnosed with gastroschisis and timing of delivery (planned versus non-planned) and mode of delivery (cesarean section versus vaginal delivery). The primary outcome evaluated was the length of hospitalization. Methods: This work was performed as a ten-year retrospective chart analysis including patients from 2005 to 2013. Inclusion in the study required a pre-operative diagnosis and a surgical intervention for gastroschisis. We identified 29 patients of interest who were filtered based on availability of the specific timing of each intervention. Chi-square test was used to determine statistical differences amongst categorical variables and the student t-test was used to determine differences amongst continuousvariables. Results: The major factors influencing the Length of hospitalization were return of bowel function (p = 0.0213) and tolerance of full oral feeds (p = 0.0116). Further early extubation was also correlated to a shorter hospitalization (p = 0.0003). Analysis of mode of delivery, comparing vaginal delivery to Cesarean section, showed that patients delivered by Cesarean section had a reduced length of hospitalization as compared to those delivered vaginally (p = 0.0080). Mode of delivery did not significantly impact the other patient outcomes, but we did find that time to oral feeds was increased in those patients undergoing unplanned deliveries (p = 0.0176). No other outcomes were impacted by undergoing a planned versus unplanned gastroschisis delivery. Conclusion: Our data suggests that patients delivered without prior planning will have an extended time to tolerance of oral feeds. In addition, we find that patients delivered by Cesarean section will have shorter lengths of hospitalizations in the setting of poor antenatal care. Factors influencing length of stay after gastroschisis, such as return of bowel function and time to tolerance of oral feeds may be related to mode and timing of delivery. We recommend that future analysis of larger databases should focus on peri-partum factors that may influence outcomes in gastroschisis. Further greater consideration should be given to the impact of lack of antenatal services in many parts of the world and its implications on maternal fetal wellbeing in congenital malformations such as gastroschisis.
Article TypeResearch Article
Publication historyReceived: Sat 21, Dec 2019
Accepted: Sat 04, Jan 2020
Published: Thu 09, Jan 2020
Copyright© 2021 Burjonrappa Sathyaprasad. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository. All rights reserved.