Download PDF
Eur J Pediatr Surg 2023; 33(06): 477-484
DOI: 10.1055/s-0043-1761921
Original Article

Impact of Social Vulnerability on Long-Term Growth Outcomes in Sutureless Versus Sutured Repair of Gastroschisis

Mark Barry 
1   Department of Surgery, University of California San Francisco, San Francisco, California, United States
,
Aileen Gozali
2   School of Medicine, University of California San Francisco, San Francisco, California, United States
,
Lan Vu
3   Division of Pediatric Surgery, University of California San Francisco, San Francisco, California, United States
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Introduction The purpose of this study is to describe the long-term growth and nutrition outcomes of sutureless versus sutured gastroschisis repair. We hypothesized that weight z-score at 1 year would be affected by social determinants of health measured by the U.S. Centers for Disease Control Social Vulnerability Index (SVI).

Materials and Methods We conducted a single-center retrospective review of patients who underwent gastroschisis repair (n = 97) from 2007 to 2018. Growth z-scores collected through 5 years of age and long-term clinical outcomes were compared based on the closure method and the type of gastroschisis (simple vs. complicated). Multiple regression analysis was performed to identify the impact of SVI themes and other covariates on weight for age z-score at 1 year.

Results In total, 46 patients underwent sutureless repair and 51 underwent sutured repair with median follow-up duration of 2.5 and 1.9 years, respectively. Weight and length z-scores decreased after birth but normalized within the first year of life. Growth and long-term clinical outcomes were similar regardless of the closure method, while patients with complicated gastroschisis had higher rates of hospitalizations, small bowel obstructions, and additional abdominal surgeries. Using multiple regression, both low discharge weight and high SVI in the “minority status and language” theme were associated with lower weight for age z-scores at 1 year (p = 0.003 and p = 0.03).

Conclusion Sutureless and sutured gastroschisis repairs result in similar growth and long-term outcomes. Patients living in areas with greater social vulnerability may be at increased risk of poor weight gain. Patients should be followed at least through their first year to ensure appropriate growth.

Keywords

gastroschisis - sutureless repair - social vulnerability - social determinants of health - growth

Authorship Statement

All authors participated in study design, data interpretation, and drafting and revision of the manuscript. All authors approve of the manuscript and agree to be accountable for all aspects of the work. In addition, M.B. and A.G. collected patient data, M.B. performed the statistical analysis, and L.V. supervised the study.


Supplementary Material



Publication History

Received: 19 August 2022

Accepted: 04 November 2022

Article published online:
31 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Sandler A, Lawrence J, Meehan J, Phearman L, Soper R. A “plastic” sutureless abdominal wall closure in gastroschisis. J Pediatr Surg 2004; 39 (05) 738-741
    CrossrefPubMedGoogle Scholar
  • 2 Chesley PM, Ledbetter DJ, Meehan JJ, Oron AP, Javid PJ. Contemporary trends in the use of primary repair for gastroschisis in surgical infants. Am J Surg 2015; 209 (05) 901-905 , discussion 905–906
    CrossrefPubMedGoogle Scholar
  • 3 Grabski DF, Hu Y, Vavolizza RD. et al. Sutureless closure: a versatile treatment for the diverse presentations of gastroschisis. J Perinatol 2019; 39 (05) 666-672
    CrossrefPubMedGoogle Scholar
  • 4 Fraser JD, Deans KJ, Fallat ME. et al; Midwest Pediatric Surgery Consortium. Sutureless vs sutured abdominal wall closure for gastroschisis: operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2020; 55 (11) 2284-2288
    CrossrefPubMedGoogle Scholar
  • 5 Witt RG, Zobel M, Padilla B, Lee H, MacKenzie TC, Vu L. Evaluation of clinical outcomes of sutureless vs sutured closure techniques in gastroschisis repair. JAMA Surg 2019; 154 (01) 33-39
    CrossrefPubMedGoogle Scholar
  • 6 Dariel A, Poocharoen W, de Silva N, Pleasants H, Gerstle JT. Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation. Eur J Pediatr Surg 2015; 25 (01) 34-40
    PubMedGoogle Scholar
  • 7 Orion KC, Krein M, Liao J, Shaaban AF, Pitcher GJ, Shilyansky J. Outcomes of plastic closure in gastroschisis. Surgery 2011; 150 (02) 177-185
    CrossrefPubMedGoogle Scholar
  • 8 Riboh J, Abrajano CT, Garber K. et al. Outcomes of sutureless gastroschisis closure. J Pediatr Surg 2009; 44 (10) 1947-1951
    CrossrefPubMedGoogle Scholar
  • 9 Payne NR, Simonton SC, Olsen S, Arnesen MA, Pfleghaar KM. Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause. BMC Pediatr 2011; 11: 90
    CrossrefPubMedGoogle Scholar
  • 10 De Bie F, Swaminathan V, Johnson G, Monos S, Adzick NS, Laje P. Long-term core outcomes of patients with simple gastroschisis. J Pediatr Surg 2021; 56 (08) 1365-1369
    CrossrefPubMedGoogle Scholar
  • 11 Harris EL, Minutillo C, Hart S. et al. The long term physical consequences of gastroschisis. J Pediatr Surg 2014; 49 (10) 1466-1470
    CrossrefPubMedGoogle Scholar
  • 12 Arnold HE, Baxter KJ, Short HL. et al. Short-term and family-reported long-term outcomes of simple versus complicated gastroschisis. J Surg Res 2018; 224: 79-88
    CrossrefPubMedGoogle Scholar
  • 13 Friedmacher F, Hock A, Castellani C, Avian A, Höllwarth ME. Gastroschisis-related complications requiring further surgical interventions. Pediatr Surg Int 2014; 30 (06) 615-620
    CrossrefPubMedGoogle Scholar
  • 14 Agency for Toxic Substances and Disease Registry (ATSDR) Geospatial Research, Analysis, and Services Program. CDC/ATSDR Social Vulnerability Index Database – 2010, 2014, 2016, 2018. Accessed on January 2022, at: https://www.atsdr.cdc.gov/placeandhealth/svi/data_documentation_download.html
    PubMed
  • 15 Hyer JM, Tsilimigras DI, Diaz A. et al. High social vulnerability and “textbook outcomes” after cancer operation. J Am Coll Surg 2021; 232 (04) 351-359
    CrossrefPubMedGoogle Scholar
  • 16 Azap RA, Hyer JM, Diaz A, Paredes AZ, Pawlik TM. Association of county-level vulnerability, patient-level race/ethnicity, and receipt of surgery for early-stage hepatocellular carcinoma. JAMA Surg 2021; 156 (02) 197-199
    CrossrefPubMedGoogle Scholar
  • 17 Azap RA, Diaz A, Hyer JM. et al. Impact of race/ethnicity and county-level vulnerability on receipt of surgery among older medicare beneficiaries with the diagnosis of early pancreatic cancer. Ann Surg Oncol 2021; 28 (11) 6309-6316
    CrossrefPubMedGoogle Scholar
  • 18 Perez NP, Ahmad H, Alemayehu H, Newman EA, Reyes-Ferral C. The impact of social determinants of health on the overall wellbeing of children: a review for the pediatric surgeon. J Pediatr Surg 2022; 57 (04) 587-597
    CrossrefPubMedGoogle Scholar
  • 19 Centers for Disease Control and Prevention, National Center for Health Statistics. WHO Growth Charts. Accessed on November 2021, at: https://www.cdc.gov/growthcharts/who_charts.htm
    PubMed
  • 20 Centers for Disease Control and Prevention, National Center for Health Statistics. CDC Growth Charts. Accessed on November 2021, at: https://www.cdc.gov/growthcharts/clinical_charts.htm
    PubMed
  • 21 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 22 Chou JH, Roumiantsev S, Singh R. PediTools electronic growth chart calculators: applications in clinical care, research, and quality improvement. J Med Internet Res 2020; 22 (01) e16204
    CrossrefPubMedGoogle Scholar
  • 23 United States Census Bureau. Census Geocoder. Accessed on December 2021, at: https://geocoding.geo.census.gov/
    PubMed
  • 24 Fraser JA, Deans KJ, Fallat ME. et al; Midwest Pediatric Surgery Consortium. Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure. J Pediatr Surg 2022; 57 (12) 786-791
    CrossrefPubMedGoogle Scholar
  • 25 Haghshenas M, Rolle U, Hutter M, Theilen TM. Incidence of surgical procedures for gastrointestinal complications after abdominal wall closure in patients with gastroschisis and omphalocele. Pediatr Surg Int 2021; 37 (11) 1531-1542
    CrossrefPubMedGoogle Scholar
  • 26 Risby K, Husby S, Qvist N, Jakobsen MS. High mortality among children with gastroschisis after the neonatal period: a long-term follow-up study. J Pediatr Surg 2017; 52 (03) 431-436
    CrossrefPubMedGoogle Scholar
  • 27 Ragavan MI, Cowden JD. The complexities of assessing language and interpreter preferences in pediatrics. Health Equity 2018; 2 (01) 70-73
    CrossrefPubMedGoogle Scholar
  • 28 Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR. The “battle” of managing language barriers in health care. Clin Pediatr (Phila) 2016; 55 (14) 1318-1327
    CrossrefPubMedGoogle Scholar
  • 29 Karliner LS, Pérez-Stable EJ, Gregorich SE. Convenient access to professional interpreters in the hospital decreases readmission rates and estimated hospital expenditures for patients with limited English proficiency. Med Care 2017; 55 (03) 199-206
    CrossrefPubMedGoogle Scholar
  • 30 Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res 2007; 42 (02) 727-754
    CrossrefPubMedGoogle Scholar