Assessment of transfer-time and time-to-surgery as risk factors to survival in Gastroschisis (GS) in a LMIC; an eight-year review
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In brief
In brief
This 8-year retrospective study from an African tertiary center examines gastroschisis outcomes in a low-middle income setting, where overall survival was 34.5%. Key findings show that transfer times under 8 hours and surgical intervention within 12 hours of birth significantly improve survival, with primary closure techniques yielding better outcomes than staged approaches.
- Transfer time under 8 hours significantly improves gastroschisis survival (46% vs lower rates with delayed transfer).
- Surgical intervention within 12 hours of birth shows statistically significant improvement in outcomes (45% survival).
- Primary closure achieves better survival than staged closure (51% vs 18%) in this LMIC tertiary center.
- Simple gastroschisis has markedly better survival than complex cases (40% vs 10%).
- Overall gastroschisis survival remains critically low at 34.5% in this African tertiary center despite protocol optimization.
Written by the GCMD Library team from the article.
Abstract
Background
The management of Gastroschisis in LMICs continues to be a challenge and is associated with very poor outcomes in contrast with HICs where survival rates near 100%. The purpose of this work is to provide an overview of survival over the past 8 years in a high-flow tertiary centre in Africa. It also investigates the effect of transfer-time and time-to-surgery on outcome.
Methods
Retrospective case note review of all GS admissions. The variables assessed were gender, gestational age, weight, type of GS, transfer time, time to surgery and type of surgery. The primary outcome was survival.
Results
A total of 171 GS cases were identified: 148 simple, 23 complex. Seven died before surgery. The median age at surgical intervention was 8.5 h (range, 0–48). Closure options ranged from single-staged (primary fascial, skin, umbilical flap and sutureless closure) or a staged (silo) closure. Overall survival was 34.5%. Cases transferred under 8 h had a 46% survival. Surgery under 12 h of life had highest survival, 45%. Simple GS survived better than complex GS (40% vs 10%). Primary closure had a significantly better survival compared to staged closure (51% vs 18%).
Conclusions
Transfer-time < 8 h plays a vital role in survival of GS cases. Surgical intervention within 12 h of birth showed a statistically significant improvement in outcome. Primary closure was associated with better survival rates.
Level of Evidence
Level III.