Gurien Lori A, Dassinger Melvin S, Burford Jeffrey M, Saylors Marie E, Smith Samuel D
Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA.
Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA.
J Pediatr Surg. 2017 Nov;52(11):1751-1754. doi: 10.1016/j.jpedsurg.2017.02.008. Epub 2017 Feb 21.
There is no consensus on optimal timing of gastroschisis repair. The 2012-2014 ACS NSQIP Pediatric Participant Use Data File was used to compare outcomes of primary versus staged gastroschisis repair.
Cases were divided into primary repair (0-1day) and staged repair (4-14days). Baseline characteristics and outcomes were compared for primary versus staged closure using Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Length of stay was compared after controlling for prematurity.
There were 627 subjects included, with 364 neonates in the primary group and 263 in the staged group. The primary group demonstrated shorter hospital length of stay (LOS) (5.1days; p<0.001) and had less surgical site infections (OR=0.27; p=0.003), but had longer ventilator days (1.9days; p<0.001). Neonates in the primary repair group were less likely to be discharged home versus transferred to another hospital (OR=0.24; p=0.006) and more likely to require nutritional support at discharge (OR=1.74; p=0.034). No significant differences were identified for mortality, readmissions, postoperative LOS, sepsis or other outcomes.
Staged repair of gastroschisis has longer LOS attributed to preoperative timing, but less ventilator days. Outcomes for these closure techniques are equivocal and support surgeons performing the closure technique they are most experienced with.
III (Treatment: retrospective comparative study).
对于腹裂修补的最佳时机尚无共识。使用2012 - 2014年美国外科医师学会国家外科质量改进计划（ACS NSQIP）儿科参与者使用数据文件来比较一期与分期腹裂修补的结果。
病例分为一期修补（0 - 1天）和分期修补（4 - 14天）。使用Fisher精确检验比较分类变量的一期与分期关闭的基线特征和结果，使用Wilcoxon秩和检验比较连续变量。在控制早产因素后比较住院时间。
共纳入627名受试者，一期组有364例新生儿，分期组有263例。一期组住院时间较短（5.1天；p<0.001），手术部位感染较少（OR = 0.27；p = 0.003），但呼吸机使用天数较长（1.9天；p<0.001）。一期修补组的新生儿出院回家而非转至其他医院的可能性较小（OR = 0.24；p = 0.006），出院时需要营养支持的可能性较大（OR = 1.74；p = 0.034）。在死亡率、再入院率、术后住院时间、败血症或其他结果方面未发现显著差异。
腹裂的分期修补由于术前时间安排导致住院时间较长，但呼吸机使用天数较少。这些关闭技术的结果不明确，支持外科医生采用他们最有经验的关闭技术。
III级（治疗：回顾性比较研究）。
