TY - JOUR
T1 - Implementing a standardized gastroschisis protocol significantly increases the rate of primary sutureless closure without compromising closure success or early clinical outcomes
AU - Canadian Pediatric Surgery Network (CAPSNet)
AU - Joharifard, Shahrzad
AU - Trudeau, Maeve O.Neill
AU - Miyata, Shin
AU - Malo, Josianne
AU - Bouchard, Sarah
AU - Beaunoyer, Mona
AU - Brocks, Rebecca
AU - Lemoine, Caroline
AU - Villeneuve, Andréanne
N1 - Funding Information:
The authors would like to thank Ms. Priscilla Chan (CNN coordinator) and Ms. Crystal Ng (CAPSNet coordinator) for their assistance in accessing the necessary data. We would also like to thank Dr. Junmin Yang, biostatistician with the Maternal–Infant Care program of the Canadian Institutes for Health Research, for performing the statistical analyses.
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - Purpose: Standardized protocols have been shown to improve outcomes in several pediatric surgical conditions. We implemented a multi-disciplinary gastroschisis practice bundle at our institution in 2013. We sought to evaluate its impact on closure type and early clinical outcomes. Methods: We performed a retrospective review of uncomplicated gastroschisis patients treated at our institution between 2008–2019. Patients were divided into two groups: pre- and post-protocol implementation. Multivariate logistic regression was used to compare closure location, method, and success. Results: Neonates (pre-implementation n = 53, post-implementation n = 43) were similar across baseline variables. Successful immediate closure rates were comparable (75.5% vs. 72.1%, p = 0.71). The proportion of bedside closures increased significantly after protocol implementation (35.3% vs. 95.4%, p < 0.01), as did the proportion of sutureless closures (32.5% vs. 71.0%, p < 0.01). Median postoperative mechanical ventilation decreased significantly (4 days IQR [3, 5] vs. 2 days IQR [1, 3], p < 0.01). Postoperative complications and duration of parenteral nutrition were equivalent. After controlling for potential confounding, infants in the post-implementation group had a 44.0 times higher odds of undergoing bedside closure (95% CI: 9.0, 215.2, p < 0.01) and a 7.7 times higher odds of undergoing sutureless closure (95% CI: 2.3, 25.1, p < 0.01). Conclusions: Implementing a standardized gastroschisis protocol significantly increased the proportion of immediate bedside sutureless closures and decreased the duration of mechanical ventilation, without increasing postoperative complications. Level of Evidence III Type of Study Retrospective comparative study.
AB - Purpose: Standardized protocols have been shown to improve outcomes in several pediatric surgical conditions. We implemented a multi-disciplinary gastroschisis practice bundle at our institution in 2013. We sought to evaluate its impact on closure type and early clinical outcomes. Methods: We performed a retrospective review of uncomplicated gastroschisis patients treated at our institution between 2008–2019. Patients were divided into two groups: pre- and post-protocol implementation. Multivariate logistic regression was used to compare closure location, method, and success. Results: Neonates (pre-implementation n = 53, post-implementation n = 43) were similar across baseline variables. Successful immediate closure rates were comparable (75.5% vs. 72.1%, p = 0.71). The proportion of bedside closures increased significantly after protocol implementation (35.3% vs. 95.4%, p < 0.01), as did the proportion of sutureless closures (32.5% vs. 71.0%, p < 0.01). Median postoperative mechanical ventilation decreased significantly (4 days IQR [3, 5] vs. 2 days IQR [1, 3], p < 0.01). Postoperative complications and duration of parenteral nutrition were equivalent. After controlling for potential confounding, infants in the post-implementation group had a 44.0 times higher odds of undergoing bedside closure (95% CI: 9.0, 215.2, p < 0.01) and a 7.7 times higher odds of undergoing sutureless closure (95% CI: 2.3, 25.1, p < 0.01). Conclusions: Implementing a standardized gastroschisis protocol significantly increased the proportion of immediate bedside sutureless closures and decreased the duration of mechanical ventilation, without increasing postoperative complications. Level of Evidence III Type of Study Retrospective comparative study.
KW - Abdominal wall defects
KW - Gastroschisis
KW - Implementation science
KW - Practice bundles
KW - Quality improvement
KW - Standardized protocols
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U2 - 10.1016/j.jpedsurg.2021.09.022
DO - 10.1016/j.jpedsurg.2021.09.022
M3 - Article
C2 - 34654548
AN - SCOPUS:85117138089
VL - 57
SP - 12
EP - 17
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 1
ER -