TY - JOUR
T1 - Race and outcomes in gastroschisis repair
T2 - a nationwide analysis
AU - Song, Ye Kyung
AU - Nunez Lopez, Omar
AU - Mehta, Hemalkumar
AU - Bohanon, Fredrick J.
AU - Rojas-Khalil, Yesenia
AU - Bowen-Jallow, Kanika
AU - Radhakrishnan, Ravi S.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/11
Y1 - 2017/11
N2 - Background The incidence of gastroschisis has increased 30% between the periods 1995–2005 and 2006–2012, with the largest increase in Black neonates born to Black mothers younger than 20 years old. Objective Racial disparities in peri- and post-operative outcomes have been previously identified in several types of adult and pediatric surgical patients. Is there an association between race and clinical outcomes and healthcare resource utilization in neonates with gastroschisis? Methods Retrospective study using national administrative data from the Kid's Inpatient Database (KID) from 2006, 2009, and 2012 for neonates (age < 28 days) with gastroschisis. Multivariable logistic regression was constructed to determine the association of race and socioeconomic characteristics with complications and mortality; linear regression was used for length of stay and hospital charges. Results We identified 3846 neonates with gastroschisis that underwent surgical repair, including 676 patients with complex gastroschisis. When controlling for birth weight, payer status, socioeconomic status, and hospital characteristics, Black neonates had increased odds of having complex gastroschisis and associated atresias. Mortality was higher in patients with complex gastroschisis, patients from the lowest income quartiles, and patients with Medicaid as primary payer (compared to those with private insurance). Length of stay (LOS) was increased in patients with complex gastroschisis, birth weight < 2500 g, and Medicaid patients. Hospital charges were higher in complex gastroschisis, Black and Hispanic neonates (as compared to Whites), males, birth weight < 2500 g, and Medicaid patients. Conclusions There is an association between race and complex gastroschisis, associated intestinal atresias, and total charges in neonates with gastroschisis. In addition, income status is associated with mortality and hospital charges while payer status is associated with complications, mortality, LOS, and hospital charges. Public health and prenatal interventions should target at-risk populations to improve clinical outcomes.
AB - Background The incidence of gastroschisis has increased 30% between the periods 1995–2005 and 2006–2012, with the largest increase in Black neonates born to Black mothers younger than 20 years old. Objective Racial disparities in peri- and post-operative outcomes have been previously identified in several types of adult and pediatric surgical patients. Is there an association between race and clinical outcomes and healthcare resource utilization in neonates with gastroschisis? Methods Retrospective study using national administrative data from the Kid's Inpatient Database (KID) from 2006, 2009, and 2012 for neonates (age < 28 days) with gastroschisis. Multivariable logistic regression was constructed to determine the association of race and socioeconomic characteristics with complications and mortality; linear regression was used for length of stay and hospital charges. Results We identified 3846 neonates with gastroschisis that underwent surgical repair, including 676 patients with complex gastroschisis. When controlling for birth weight, payer status, socioeconomic status, and hospital characteristics, Black neonates had increased odds of having complex gastroschisis and associated atresias. Mortality was higher in patients with complex gastroschisis, patients from the lowest income quartiles, and patients with Medicaid as primary payer (compared to those with private insurance). Length of stay (LOS) was increased in patients with complex gastroschisis, birth weight < 2500 g, and Medicaid patients. Hospital charges were higher in complex gastroschisis, Black and Hispanic neonates (as compared to Whites), males, birth weight < 2500 g, and Medicaid patients. Conclusions There is an association between race and complex gastroschisis, associated intestinal atresias, and total charges in neonates with gastroschisis. In addition, income status is associated with mortality and hospital charges while payer status is associated with complications, mortality, LOS, and hospital charges. Public health and prenatal interventions should target at-risk populations to improve clinical outcomes.
KW - Gastroschisis
KW - Health disparities
KW - Outcomes
KW - Pediatric surgery
KW - Race
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U2 - 10.1016/j.jpedsurg.2017.03.004
DO - 10.1016/j.jpedsurg.2017.03.004
M3 - Article
C2 - 28365103
AN - SCOPUS:85016449620
SN - 0022-3468
VL - 52
SP - 1755
EP - 1759
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 11
ER -