AAP papers
Increasing prevalence of gastroschis repairs in the United States: 1996-2003

https://doi.org/10.1016/j.jpedsurg.2007.01.026Get rights and content

Abstract

Purpose

Local and state registries have shown recent increases in the prevalence of gastroschisis in the United States and abroad. The purpose of this study was to use a nationally representative database to identify national trends in the prevalence of gastroschisis repairs.

Methods

Records of infants undergoing gastroschisis repair were identified in the Nationwide Inpatient Sample from 1996 to 2003. Birth data were obtained from the National Center for Health Statistics and used to calculate the rate of procedures/live births stratified by US census region. Survey statistics were used to account for the sampling design of the Nationwide Inpatient Sample database.

Results

Between 1996 and 2003, a total of 9459 gastroschisis repairs were performed in the United States (3 procedures for every 10,000 births). A significant increase in the population-based rate of these procedures was observed in each census regions and nationwide. A twofold higher procedure rate was observed in 2003 than in 1996 (rate ratio, 2.0; 95% confidence interval, 1.1-2.9; P < .001). No significant change in unadjusted hospital mortality was observed regionally or nationally.

Conclusions

The population-based rate of gastroschisis repairs significantly increased regionally and nationwide between 1996 and 2003, paralleling recent trends described at the local and state level.

Section snippets

Data sources and subject selection

This study was approved by the institutional review board at UMDNJ-Robert Wood Johnson Medical School (IRB #4568). Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Samples (NIS) from 1996 to 2003. The NIS is a database containing discharge records obtained from a representative 20% sample of US community (nonfederal) hospitals annually. Five hospital characteristics were used for inclusion in the NIS: location (urban vs rural), ownership (public vs

Results

From 1996 to 2003, a total of 1955 gastroschisis repairs were recorded in the NIS, yielding a total national estimate of 9459 procedures (95% confidence interval [CI], 8225-10,692) during this period. Most infants were male, white, had public insurance (Medicaid or Medicare) as the primary payer source, and underwent surgery at urban, teaching hospitals. Among infants treated in states reporting individual hospital names, most procedures were performed at hospitals without a children's hospital

Discussion

A growing number of reports has described an increasing prevalence of gastroschisis in the United States and abroad [6], [7], [8], [9], [10], [21]. Most studies show that the prevalence of gastroschisis has increased over the past 3 decades, but variability in the rate of change over this period has been observed among local regions and states in the United States. A significant increase in the prevalence of gastroschisis has been reported in Utah (from 1971 to 2002), in Hawaii (1986 to 1997),

References (24)

  • H.E. Hoyme et al.

    The vascular pathogenesis of gastroschisis: intrauterine interruption of the omphalomesenteric artery

    J Pediatr

    (1981)
  • K.T. Hougland et al.

    Increasing prevalence of gastroschisis in Utah

    J Pediatr Surg

    (2005)
  • C.L. Snyder

    Outcome analysis for gastroschisis

    J Pediatr Surg

    (1999)
  • J.I. Curry et al.

    The aetiology of gastroschisis

    Br J Obstet Gynaecol

    (2000)
  • H.E. Hoyme et al.

    Gastroschisis: abdominal wall disruption secondary to early gestational interruption of the omphalomesenteric artery

    Semin Perinatol

    (1983)
  • D. Emusu et al.

    Gastroschisis, low maternal age, and fetal morbidity outcomes

    Birth Defects Res A Clin Mol Teratol

    (2005)
  • J.W. Goldkrand et al.

    The changing face of gastroschisis and omphalocele in southeast Georgia

    J Matern Fetal Neonatal Med

    (2004)
  • M.B. Forrester et al.

    Epidemiology of abdominal wall defects, Hawaii, 1986-1997

    Teratology

    (1999)
  • H.M. Salihu et al.

    Omphalocele and gastroschisis in the State of New York, 1992-1999

    Birth Defects Res A Clin Mol Teratol

    (2003)
  • L.J. Williams et al.

    Epidemiology of gastroschisis in metropolitan Atlanta, 1968 through 2000

    Birth Defects Res A Clin Mol Teratol

    (2005)
  • M. Laughon et al.

    Rising birth prevalence of gastroschisis

    J Perinatol

    (2003)
  • C.A. Williams et al.

    Ascertainment of gastroschisis using the ICD-9-CM surgical procedure code

    Birth Defects Res A Clin Mol Teratol

    (2005)

    • Cited by (0)

    Papers presented at the 58th Annual Meeting of the Section on Surgery of the American Academy of Pediatrics

    View full text
    Copyright © 2007 Elsevier Inc. All rights reserved.