Variation in hospital costs for gastroschisis closure techniques

Abstract

Background: In newborns with gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost differences have not been explored.

Methods: A retrospective review was performed of newborns admitted with gastroschisis at a single center from 2011 to 2016. Demographic, clinical, and cost data during the initial hospitalization were collected. Differences between procedure costs and clinical endpoints were analyzed using multivariable linear regression adjusting for prematurity, complicated gastroschisis, and performance of additional operations.

Results: 80 patients with gastroschisis met inclusion criteria. Rates of primary fascial, primary umbilical cord closure, and delayed closure were 14%, 65%, and 21%, respectively. Delayed closure was associated with an increase in total hospital costs by 57% compared to primary repair (p < 0.001). In addition, delayed closure was associated with increased total and NICU LOS (p < 0.05), parenteral nutrition duration (p = 0.02), ventilator days (p < 0.001), time to goal enteral feeds (p = 0.01), and all cost sub-categories except ward room costs (p < 0.01).

Conclusion: Delayed fascial closure was associated with significantly greater hospital costs during the index admission.

Keywords: Cost; Gastroschisis; Silo; Sutureless umbilical closure.

Figure 1:. Average Cost by Gastroschisis Procedure

In unadjusted analyses, delayed closure was associated with increased total hospital and increases in all inpatient cost buckets except Ward Bed when compared to primary closure. *p<0.01.

Figure 2:. Cost Breakdown Between Gastroschisis Procedures

The percentage breakdown per cost bucket from the total cost was different between delayed and primary closure. In particular, the proportion of ICU cost was increased by nearly 2-fold in delayed closure compared to primary closure. Percentage breakdown was calculated as the sum of total costs for each cost bucket divided by the total overall cost from all patients.