340 - Have the outcomes of gastroschisis improved over recent years with advanced surgical and medical management strategies?

Publication Number: 340.5484

Mohsen A.A.. Farghaly, Cleveland Clinic Children's, Cleveland, OH, United States; Melissa Andrianov, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Mahmoud Ali, West Virginia University Children's Hospital, Morgantown, WV, United States; Stacey Ramey, Cleveland Clinic Children's, Cleveland, OH, United States; Hany Aly, Cleveland Children’s Hospital, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States

Background: Recent reports showed the prevalence of gastroschisis may have been plummeted in recent years, while the morbidities and mortality associated with gastroschisis have been improved.

Objective: To examine changes in the prevalence of gastroschisis, necrotizing enterocolitis (NEC), length of hospital stay (LOS), and mortality associated with gastroschisis over the last decade.

Design/Methods: We used the national dataset produced by the healthcare cost and utilization project (HCUP) for the years 2010-2020. We identified the diagnoses using respective international classification of diseases – version 9 (ICD9) and version 10 (ICD10). We included all infants diagnosed with gastroschisis to calculate changes in trends over the years. To examine morbidities and mortalities associated with gastroschisis, we excluded infants < 32 weeks GA, < 1500g BW, infants with Trisomy 13 or 18, infants with congenital heart disease, congenital diaphragmatic hernia, or severe brain anomalies. We measured changes over time using chi square test for trends. We examined gastroschisis in different race/ethnic groups and calculated differences in morbidities and mortalities between them.

Results: The study included 42,917,930 infants, in which, 23,273 (0.54/1000) were diagnosed with gastroschisis. The prevalence of gastroschisis decreased overtime. Among infants with gastroschisis, 47.9% were females, 47.1% were Caucasians, 97.9% were singleton, and 7.0 % were SGA, and 52.9% were delivered via Cesarean delivery. NEC in association with gastroschisis was 12.8% and it significantly decreased overtime. Median LOS was 29 days, and it slightly increased overtime. Mortality was 1.83% and it did not change significantly overtime, Figure1. Compared to Caucasian infants, gastroschisis (0.43/1000) was less common in African American (0.31/1000) with odds ratios (OR): 0.72 (0.60-0,85, < 0.001), and Asian/Pacific Islander infants (0.14/1000) OR: 0.32 (0.22-0.48, < 0.001), more common in Hispanic/Latino infants (0.64/1000) OR 1.49 (1.32-1.68, 0.001). Although, showing higher trends in Native American infants (0.62/1000), it was not statistically significant, OR 1.45 (0.87-2.42, 0.15). There was no significant change in the prevalence of gastroschisis in each race/ethnicity that is different from the overall change over the years.

Conclusion(s): The prevalence of gastroschisis slightly decreased over recent years. Occurrence of NEC in association with gastroschisis, and LOS reflecting overall care have improved overtime, however, mortality in association with gastroschisis, did not significantly change.

Figure 1: Prevalence of gastroschisis/1000 birth, and incidence of necrotizing enterocolitis, median length of stay and mortality associated with gastroschisis in 2010-2020