A standardized gastroschisis protocol significantly increases the rate of primary sutureless closure | 96 neonates | 12 years | Retrospective review Uncomplicated gastroschisis patients at single institution | 53 - pre implementation | 43 - post implementation | Successful immediate closure rates (p = 0.71) | pre- 75.5% vs post- 72.1% | Proportion of bedside closures (p < 0.01) | pre- 35.3% vs post- 95.4% | Post-op complications & time on TPN equivalent | Infants in the post- group | 44.0x higher odds of bedside closure (p < 0.01) | 7.7x higher odds of sutureless closure (p < 0.01) | Conclusion: A standardized gastroschisis protocol significantly increases immediate bedside sutureless closures without increasing post operative complications | https://pubmed.ncbi.nlm.nih.gov/34654548/ | @EmTombash | @StayCurrentMD | Source: Joharifard S et al. Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada | Cincinnati Children's | Journal of Pediatric Surgery
Implementing a standardized gastroschisis protocol significantly increases the rate of primary sutureless closure without compromising closure success or early clinical outcomes
Infographic · Apr 2022 · 1 min read
In brief
In brief
This retrospective study of 96 gastroschisis patients demonstrates that implementing a standardized multidisciplinary protocol dramatically increased bedside sutureless closures (from 33% to 71%) and reduced mechanical ventilation duration by 50%, without increasing complications or affecting overall closure success rates.
- Standardized gastroschisis protocol increased bedside closures from 35% to 95% without compromising closure success rates (75% vs 72%).
- Sutureless closure rates increased from 33% to 71% post-protocol, with 7.7x higher odds after controlling for confounders.
- Median postoperative mechanical ventilation decreased from 4 days to 2 days following protocol implementation.
- Protocol implementation achieved 44x higher odds of bedside closure with no increase in postoperative complications.
- Standardized approach shifted care away from OR to bedside while maintaining equivalent complication rates and TPN duration.
Written by the GCMD Library team from the infographic.
A teal and white infographic divided into sections with icons including a calendar, baby illustration, clock, and diaper. The layout presents study data in a top-to-bottom flow with statistics highlighted in yellow text. Bar chart-style comparisons show pre- and post-implementation outcomes. Bottom section includes institutional branding and source citation.
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.