Gastroschisis outcomes in North America: a comparison of Canada and the United States

Background: Care of infants with gastroschisis is centralized in Canada and noncentralized in the United States. We conducted an outcomes comparison between the two countries and analyzed the determinants of such outcomes. Methods: Inpatient mortality and hospital stay of gastroschisis patients from the Canadian Pediatric Surgery Network prospective clinical database for the period 2005-2013 were compared with those from the US Kids Inpatient Database for the period 2003-2012. Potential outcome determinants were analyzed using univariate and multivariate analyses. Results: A comparison was made between 695 Canadian patients and 5216 American patients. Complex gastroschisis was found in 16.0% and 13.7% of patients in Canada and the US, respectively; P = 0.11. Canada had less premature births, more normal birth weight (BW) infants, less cesarean section deliveries, and more inborn patients compared to the US. For simple gastroschisis, Canadian mortality was lower (1.4% vs. 3.4%; P = .008) and hospital stay was longer (45 +/- 38 vs. 41 +/- 32 days; P = .04). US mortality correlated strongly with low BW(P = .002) and marginally with cesarean section delivery (P = .08). A longer Canadian hospital stay was associated with lower gestational age (P = 0.01) and western region (P = 0.04), while a longer American hospital stay was associated with medium neonatal intensive care unit gastroschisis volume (P = .03), low socioeconomic status (P = .06), low BW(P = 0.06), and public insurance (P = 0.07). Outcomes for complex gastroschisis did not differ between Canada and the US. Conclusions: Mortality for simple gastroschisis is higher in the US than in Canada, whereas no outcome differences exist for complex gastroschisis. Outcome determinants are different between the 2 countries. (C) 2016 Elsevier Inc. All rights reserved.