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Regional variation in gastroschisis: a nationwide database review of demographics and outcomes

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Abstract

Background

Gastroschisis is an index neonatal malformation with an increasing incidence from earlier decades. The aim of this study was to investigate regional variations in patient demographics, outcomes, and costs in gastroschisis.

Materials and methods

The 2016 kid’s inpatient database (KID) obtained from the Healthcare Cost and Utilization Project (HCUP) was used to obtain gastroschisis birth, demographic, and outcome data across four U.S. geographical regions: Northeast, Midwest, South, and West. Categorical variables were analyzed with Pearson’s Chi-squared test. Odds ratios (OR) with 95% confidence intervals (CI) were reported for variables with significance (p < 0.05). Appropriate logistic regressions were used for comparing categorical, cardinal, and continuous data.

Results

2043 gastroschisis cases were obtained from the 2016 KID database with a weighted incidence of 5.1 per 10,000 live births. Incidence of gastroschisis across regions was similar when controlling for a number of hospitals reporting to KID. Prematurity was common, with 59% (1204) of neonates with gastroschisis born at less than 37 weeks. 52% (N = 1067) of gastroschisis infants were male. 46% (955) were White, 9% (178) African American, 22% (450) Hispanic, and 8% (155) other. The overall mortality of gastroschisis in this database was 3.6% (75). The average length of stay was 39 days and average cost of treatment was $357,436. Though without significant differences in mortality, there were significant differences in demographics, costs, and lengths of stay between regions.

Conclusions

There has been a significant increase in gastroschisis incidence over the last three decades. This significant increase appears to be related to an increase in socioeconomic inequality and an alteration in the population demographics in the United States. Further study of regional variations will facilitate the development of best practice guidelines that benefit all.

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Data availability

This article is based on the KID database. The data in this database is HIPAA compliant from a de-identified subset of patients and retrospective in nature. Data use permission was obtained from the KID database prior to presentation and publication.

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Author information

Authors and Affiliations

  1. University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA

    Sathyaprasad Burjonrappa & Alana N. Snyder

  2. Robert Wood Johnson Medical School, Rutgers State University of New Jersey, 1 Robert Wood Johnson Place, MEB 504, New Brunswick, NJ, 08901, USA

    Sathyaprasad Burjonrappa

Authors
  1. Sathyaprasad Burjonrappa
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  2. Alana N. Snyder
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Contributions

ANS contributed to the data collection, data analysis, and manuscript drafting. Professor SB contributed to the conceptual development, finalization of data, and manuscript editing.

Corresponding author

Correspondence to Sathyaprasad Burjonrappa.

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Conflict of interest

Both authors do not have any conflict of interest. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Appendices

Appendix

The following lists the categorical variables that were grouped differently than the HCUP groupings. Groups were only combined. Grouping was changed only when criteria for Pearson’s Chi-squared test was not met due to a cell size < 5.

Race

The HCUP categorization of this variable an indicator of race:

  1. 1.

    White,

  2. 2.

    Black,

  3. 3.

    Hispanic,

  4. 4.

    Asian or Pacific Islander,

  5. 5.

    Native American,

  6. 6.

    Other

This variable was regrouped as:

  1. 1.

    White

  2. 2.

    Black

  3. 3.

    Hispanic

  4. 4.

    Other

Primary expected payer

The HCUP categorization of this variable an indicator of expected primary payer:

  1. 1.

    Medicare,

  2. 2.

    Medicaid,

  3. 3.

    Private including HMO,

  4. 4.

    Self-pay,

  5. 5.

    No charge,

  6. 6.

    Other

This variable was regrouped as:

(1) Medicare, Medicaid, or no charge or (2) Private, HMO, Self-pay, other.

Highlights

  • Incidence of gastroschisis is rising (~ 1 in 2000), causes are likely multifactorial

  • Mortality of gastroschisis remains low, around 3% across the U.S.

  • Premature infants were 44% of the sample, with lowest incidence in the Northeast

  • Incidence varied significantly among gender, race, and economic status by region

  • Length of stay and costs were highest in the Northeast U.S.

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Burjonrappa, S., Snyder, A.N. Regional variation in gastroschisis: a nationwide database review of demographics and outcomes. Pediatr Surg Int 37, 911–917 (2021). https://doi.org/10.1007/s00383-021-04894-2

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  • DOI: https://doi.org/10.1007/s00383-021-04894-2

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