Assessment of transfer-time and time-to-surgery as risk factors to survival in Gastroschisis (GS) in a LMIC; an eight-year review.

IF 1.5 3区医学 Q2 PEDIATRICS

Pediatric Surgery International Pub Date : 2024-11-07 DOI:10.1007/s00383-024-05872-0

Alaa Obeida, Rawan El-Hussein, Hadeer Mohamed NasrEldin, Mohammad Allam, Khaled Bahaaeldin, Sherif Kaddah, Aly Shalaby

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引用次数: 0

Abstract

Background: The management of Gastroschisis in LMICs continues to be a challenge and is associated with very poor outcomes in contrast with HICs where survival rates near 100%. The purpose of this work is to provide an overview of survival over the past 8 years in a high-flow tertiary centre in Africa. It also investigates the effect of transfer-time and time-to-surgery on outcome.

Methods: Retrospective case note review of all GS admissions. The variables assessed were gender, gestational age, weight, type of GS, transfer time, time to surgery and type of surgery. The primary outcome was survival.

Results: A total of 171 GS cases were identified: 148 simple, 23 complex. Seven died before surgery. The median age at surgical intervention was 8.5 h (range, 0-48). Closure options ranged from single-staged (primary fascial, skin, umbilical flap and sutureless closure) or a staged (silo) closure. Overall survival was 34.5%. Cases transferred under 8 h had a 46% survival. Surgery under 12 h of life had highest survival, 45%. Simple GS survived better than complex GS (40% vs 10%). Primary closure had a significantly better survival compared to staged closure (51% vs 18%).

Conclusions: Transfer-time < 8 h plays a vital role in survival of GS cases. Surgical intervention within 12 h of birth showed a statistically significant improvement in outcome. Primary closure was associated with better survival rates.

Level of evidence: Level III.

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评估转运时间和手术时间对腹股沟畸形（GS）患者存活率的风险因素；八年回顾。

背景：在低收入和中等收入国家，胃畸形的治疗仍然是一项挑战，与高收入国家接近 100%的存活率相比，低收入和中等收入国家的胃畸形治疗效果非常差。本研究旨在概述非洲一个高流量三级中心过去 8 年的存活率。本文还调查了转院时间和手术时间对结果的影响：方法：对所有GS入院病例进行回顾性病例记录。评估变量包括性别、胎龄、体重、GS 类型、转运时间、手术时间和手术类型。主要结果是存活率：结果：共确定了 171 例 GS，其中 148 例为简单型，23 例为复杂型：结果：共发现 171 例 GS：148 例为简单型，23 例为复杂型。7例在手术前死亡。手术干预的中位年龄为 8.5 小时（0-48 小时不等）。闭合方案包括单阶段（初级筋膜、皮肤、脐瓣和无缝线闭合）或分阶段（筒仓式）闭合。总存活率为 34.5%。8 小时内转运的病例存活率为 46%。12 小时内手术的存活率最高，为 45%。简单胃肠道手术的存活率高于复杂胃肠道手术（40% 对 10%）。初级闭合术的存活率明显高于分期闭合术（51% vs 18%）：转运时间证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Surgery International 医学-外科

CiteScore

3.00

自引率

5.60%

发文量

215

审稿时长

3-6 weeks

期刊介绍： Pediatric Surgery International is a journal devoted to the publication of new and important information from the entire spectrum of pediatric surgery. The major purpose of the journal is to promote postgraduate training and further education in the surgery of infants and children. The contents will include articles in clinical and experimental surgery, as well as related fields. One section of each issue is devoted to a special topic, with invited contributions from recognized authorities. Other sections will include: -Review articles- Original articles- Technical innovations- Letters to the editor