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Adherence to and outcomes of a University-Consortium gastroschisis pathway

2019; Elsevier BV; Volume: 55; Issue: 1 Linguagem: Inglês

10.1016/j.jpedsurg.2019.09.048

1531-5037

Daniel A. DeUgarte, Kara L. Calkins, Yigit S. Guner, Jae Kim, Karen Kling, Katelin Kramer, Hanmin Lee, Leslie Lusk, Payam Saadai, Cherry Uy, Catherine A. Rottkamp, Jamie E. Anderson, Aubrey Blanton, Nina M. Boe, Erin G. Brown, Michael Choy, Raymond Dougherty, Diana L. Farmer, Nancy T. Field, Laura A. Galganski, Hedriana Herman, Shinjiro Hirose, Gina James, Elyse Love, John P. McGahan, Amelia McLennan, Giselle Melendres, Francis R. Poulain, Amy Powne, Gary W. Raff, Laila Rhee Morris, Catherine A. Rottkamp, Payam Saadai, David Schrimmer, Simran Sekhohn, Sherzana Sunderji, Véronique Taché, Melissa Vanover, Jay Yeh, M. Baraa Allaf, Katie Bacca, Elizabeth Blumenthal, Kari G. Bruce, Lisa Carroll, Robert Day, Jennifer Duffy, David Gibbs, Yigit S. Guner, Afshan Hameed, Tamara Hatfield, Alexandra Iacob, Jennifer Jolley, Mustafa H. Kabeer, Nafiz Kiciman, Nancy Y. Lee, Carol Major, Joshua Makhoul, Yona Nicolau, Elizabeth Patberg, Christina A. Penfield, Manuel Porto, Pamela Rumney, Valeria Simon, Lizette Spiers, Cherry Uy, Melissa Westermann, Peter T. Yu, Kara L. Calkins, Judith H. Chung, Ilina Datkhaeva, Daniel A. DeUgarte, Uday Devaskar, Jaime Deville, Rachel Gutkin, Carla Janzen, Howard C. Jen, Daniel Kahn, Suhas G. Kallapur, Steven Lee, Steven E. Lerman, Melanie Maykin, Aisling Murphy, Tina Nguyen, Victoria Niklas, Rashmi Rao, Gary Satou, Emily Scibetta, Mark Sklansky, Rebecca Stark, Katie M. Strobel, Renea Sturm, Khalil Tabsh, Afshar Yalda, Rebecca Adami, Laith Alshawabkeh, Tracy Anton, Jerasimos Ballas, Stephen W. Bickler, Divya Chhabra, Charlotte L. Conturie, Erika Fernandez, Aileen Fernando, Neil N. Finer, Andrew Hull, Diana Johnson, Jae Kim, Karen Kling, Leah Lamale‐Smith, Louise C. Laurent, Frank L. Mannino, Dora J. Melber, Mishella Perez, Andrew C. Picel, Dolores Pretorius, Sandy Ramos, D. Sanford, Maryam Tarsa, Vy Tran, Douglas Woelkers, Kathy Zhang‐Rutledge, Katie Archbold, Victoria Berger, Paul Brakeman, Melissa Catenacci, Shilpa Chetty, Hillary L. Copp, Emily Edwards, Vickie A. Feldstein, Neda Ghaffari, Ruth B. Goldstein, Juan M. González, Kristen Gosnell, Joanne Gras, Michael R. Harrison, Whitnee Hogan, Romobia Hutchinson, Roxanna A. Irani, Priyanka Jha, Roberta L. Keller, Maureen P. Kohi, Katherine A. Kosiv, Katie Kramer, Hanmin Lee, Billie R. Lianoglou, Jennifer Lucero, Tippi C. MacKenzie, Anne H. Mardy, Erin Matsuda, Edward Miller, Anita J. Moon‐Grady, Tara A. Morgan, Amy Murtha, Mary E. Norton, Natalie Oman, Benjamin E. Padilla, Shabnam Peyandi, Andrew Phelps, Liina Pōder, Annalisa Post, Larry Rand, Naseem Rangwala, Frederico G. Rocha, Mark D. Rollins, Melissa G. Rosenstein, Janice Scudmore, Rachel Shulman, Dorothy J. Shum, Teresa N. Sparks, Jeffrey D. Sperling, Katherine Swanson, Martha Tesfalul, Stephanie L. Gaw, Lan Vu, Amanda Yeaton‐Massey, Lisa Arcilla, Stacie Bennett, Erin Corbett, Leslie Lusk, Howard Rosenfeld,

Congenital Diaphragmatic Hernia Studies

Our multi-institutional university consortium implemented a gastroschisis pathway in 2015 to standardize and improve care by promoting avoidance of routine intubation and paralysis during silo placement, expeditious abdominal wall closure, discontinuation of antibiotics/narcotics within 48 h of closure, and early initiation/advancement of feeds.Adherence to the gastroschisis pathway was prospectively monitored. Outcomes for the contemporary cohort (2015-2018) were compared with a historical cohort (2007-2012).Good adherence to the pathway was observed for 70 cases of inborn uncomplicated gastroschisis. The contemporary cohort had significantly lower median mechanical ventilator days (2 versus 5; p < 0.01) and antibiotic days (5.5 versus 9; p < 0.01) as well as earlier days to initiation of feeds (12 versus 15; p < 0.01). However, no differences were observed in length of stay (28 versus 29 days; p = 0.70). A skin closure technique was performed in 66% of the patients, of which 46% were performed at bedside without intubation, the assistance of an operating-room team, or general anesthesia.In this study, adherence to a clinical pathway for gastroschisis across different facilities was feasible and led to reduction in exposure to mechanical ventilation and antibiotics. The adoption of a bedside skin closure technique appears to facilitate compliance with the pathway.Level II/III TYPE OF STUDY: Prospective comparative study with historical cohort.