Factors Associated with Hospital Readmission One Year Post-Discharge in Infants with Gastroschisis

John P Marquart; Devashis Mukherjee; Bethany N Canales; Katherine T Flynn-O'Brien; Aniko Szabo; Amy J Wagner

doi:10.1159/000531449

Factors Associated with Hospital Readmission One Year Post-Discharge in Infants with Gastroschisis

Fetal Diagn Ther. 2023;50(5):344-352. doi: 10.1159/000531449. Epub 2023 Jun 7.

Authors

John P Marquart¹, Devashis Mukherjee², Bethany N Canales³, Katherine T Flynn-O'Brien¹, Aniko Szabo³, Amy J Wagner¹

Affiliations

¹ Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, Wisconsin, USA.
² Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
³ Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

PMID: 37285815
DOI: 10.1159/000531449

Abstract

Introduction: Gastroschisis is the most common congenital abdominal wall defect with a rising prevalence. Infants with gastroschisis are at risk for multiple complications, leading to a potential increased risk for hospital readmission after discharge. We aimed to find the frequency and factors associated with an increased risk of readmission.

Methods: A retrospective analysis of infants born with gastroschisis between 2013 and 2019 who received initial surgical intervention and follow-up care in the Children's Wisconsin health system was performed. The primary outcome was the frequency of hospital readmission within 1 year of discharge. We also compared maternal and infant clinical and demographic variables between those readmitted for reasons related to gastroschisis, and those readmitted for other reasons or not readmitted.

Results: Forty of 90 (44%) infants born with gastroschisis were readmitted within 1-year of the initial discharge date, with 33 (37%) of the 90 infants being readmitted due to reasons directly related to gastroschisis. The presence of a feeding tube (p < 0.0001), a central line at discharge (p = 0.007), complex gastroschisis (p = 0.045), conjugated hyperbilirubinemia (p = 0.035), and the number of operations during the initial hospitalization (p = 0.044) were associated with readmission. Maternal race/ethnicity was the only maternal variable associated with readmission, with Black race being less likely to be readmitted (p = 0.003). Those who were readmitted were also more likely to be seen in outpatient clinics and utilize emergency healthcare resources. There was no statistically significant difference in readmission based on socioeconomic factors (all p > 0.084).

Conclusion: Infants with gastroschisis have a high hospital readmission rate, which is associated with a variety of risk factors including complex gastroschisis, multiple operations, and the presence of a feeding tube or central line at discharge. Improved awareness of these risk factors may help stratify patients in need of increased parental counseling and additional follow-up.

Keywords: Gastroschisis; NICU; Readmission.