Avoidance of routine endotracheal intubation and general anesthesia for primary closure of gastroschisis: a systematic review and meta-analysis
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In brief
In brief
This systematic review and meta-analysis of 12 studies (248 patients) evaluates primary bedside closure of gastroschisis without general anesthesia versus traditional closure with intubation. Results show no significant difference in closure success or mortality, with equivalent or improved outcomes for time to feeding and hospital stay when avoiding routine intubation.
Written by the GCMD Library team from the article.
Abstract
Purpose
Over the last few decades, several articles have examined the feasibility of attempting primary reduction and closure of gastroschisis without general anesthesia (GA). We aimed to systematically evaluate the impact of forgoing routine intubation and GA during primary bedside reduction and closure of gastroschisis.
Methods
The primary outcome was closure success. Secondary outcomes were mortality, time to enteral feeding, and length of hospital stay.
Results
12 studies were included: 5 comparative studies totalling 192 patients and 7 descriptive case studies totalling 56 patients. Primary closure success was statistically equivalent between the two groups, but trended toward improved success with GA/intubation (RR = 0.86, CI 0.70–1.03, p = 0.08). Mortality was equivalent between groups (RR = 1.26, CI 0.26–6.08, p = 0.65). With respect to time to enteral feeds and length of hospital stay, outcomes were either equivalent between the two groups or favored the group that underwent primary closure without intubation and GA.
Conclusion
There are few comparative studies examining the impact of performing primary bedside closure of gastroschisis without GA. A meta-analysis of the available data found no statistically significant difference when forgoing intubation and GA. Foregoing GA also did not negatively impact time to enteral feeds, length of hospital stay, or mortality.