The Impact of Infectious Complications in Gastroschisis on Costs and Length of Stay Open Access

Abstract

Purpose: Gastroschisis (GS) is the most common congenital abdominal wall defect and the incidence is rising. Management and outcomes for GS remain highly variable. Infectious complications have been shown to adversely impact the care of GS patients. Our objective was to provide estimates of the impact of infectious complications on length of stay (LOS) and costs.

Methods:Using an adminstrative national discharge database, 1,378 patients with GS were identified. Patient and hospital level characterisics were compared for patients with and without infectious complications. LOS and costs were evaluated using regression models controlling for patient and hospital level factors as well as for the type of infectious complication.

Results: Two-thirds of all GS patients had infectious complications. Infectious complications were common for both simple and complex GS (63.5%, 73.1%). After controlling for patient and hospital factors including simple versus complex GS, LOS in patients with infection was significantly higher than in patients with no infection (unadjusted 39 days vs. 32 days, p=<0.001, adjusted 4.5 day increased LOS, p=0.001). Specifically, sepsis was associated with increasing median LOS by 11 days (p=<0.0001), candida infection by 14 days (p=0.0004), and wound infection by 7 days (p=0.007). Although costs did not differ between patients with and without infection, on stratified analyses for specific infection type costs were elevated. Sepsis increased the median costs by $22,380 (95% Confidence Interval (CI):$14,372-$30,388;p=<0.0001), wound infection increased costs by $32,351 (95%CI:$17,221-$47,481;p=<0.0001), catheter-related infection (CRI) 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: Infectious complications among GS patients are common and are important drivers of increased costs and prolonged LOS. We provide national estimates in terms of dollar figures and number of days increased by specific infectious complications that may help guide future investment toward quality improvement efforts.

Table of Contents

Chapter 1: Introduction 1

Epidemiology 1

Pathophysiology 2

Treatment 3

Chapter 2: Review of Literature 4

Table 1: Trends of incidence of gastroschisis worldwide 4

Table 2: Risk factors for gastroschisis 5

Figure 1: Classic ultrasound of gastroschisis 7

Chapter 3: Manuscript 13

Title page for manuscript 13

Contribution of student 13

Abstract 14

Introduction 15

Methods 16

Overview 16

Study population 16

Definition of variables 18

Statistical analysis 20

IRB approval 20

Results 21

Demographics 21

Estimated LOS and costs 22

Specific infections 23

Discussion 23

References 26

Tables and Figures 29

Table 1: Characteristics of the study population with gastroschisis using the Kids' Inpatient Database 2012 29

Table 2: Unadjusted Median for LOS in days and fully adjusted model on median LOS in days 30

Table 3: Unadjusted median for costs in USD and fully adjusted model on median costs in USD 31

Table 4: Unadjusted LOS for specific infections and fully adjusted model on median LOS in days 32

Table 5: Unadjusted costs for specific infections and fully adjusted model on median costs in USD 33

Figure 1: Selection of patients with gastroschisis from the KID database 2012 34

Figure 2: Length of stay (LOS) in days and costs for patients with gastroschisis in the 2012 Kids Inpatient

Database comparing patient characteristics 35

Conclusion and Recommendations 36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery
Keyword	Infection Costs LOS Gastroschisis
Committee Chair / Thesis Advisor	Raval, Mehul V, Emory University
Committee Members	Del Rio, Carlos, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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