Am J Perinatol 2017; 34(01): 62-69
DOI: 10.1055/s-0036-1584299
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Influence of Infectious Complications in Gastroschisis on Costs and Length of Stay

Monika Uribe-Leitz
1  Rollins School of Public Health, Emory University, Atlanta, Georgia
,
Courtney E. McCracken
2  Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
,
Kurt F. Heiss
3  Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
,
Mark L. Wulkan
3  Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
,
Mehul V. Raval
3  Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

11 January 2016

27 April 2016

Publication Date:
30 May 2016 (online)

Abstract

Objective Outcomes for gastroschisis (GS) remain highly variable and avoiding infectious complications (ICs) may represent a significant improvement opportunity. Our objective was to provide estimates of the impact of IC on length of stay (LOS) and costs.

Study Design Using a national database, 1,378 patients with GS were identified. Patient and hospital characteristics were compared and LOS and costs evaluated for patients with and without IC.

Results Two-thirds of all GS patients had IC, and IC were common for simple and complex GS (65, 73%, respectively). After controlling for patient and hospital factors, LOS in patients with IC was significantly longer than in patients without IC (4.5-day increase, p = 0.001). Specifically, sepsis was associated with increasing median LOS by 11 days (p ≤ 0.001), candida infection by 14 days (p < 0.001), and wound infection by 7 days (p = 0.007). Although overall costs did not differ between patients with and without IC, costs were elevated based on specific IC. Sepsis increased median costs by $22,380 (95% confidence interval [CI]: $14,372–30,388; p ≤ 0.001), wound infection by $32,351 (95% CI: $17,221–47,481; p ≤ 0.001), catheter-related infection by $57,180 (95% CI: $12,834–101,527; p = 0.011), and candida infections by $24,500 (95% CI: $8,832–40,167; p = 0.002).

Conclusion IC among GS patients are common and contribute to increased LOS and costs. Quantifying clinical and financial ramifications of IC may help direct future quality improvement efforts.

Supplementary Material