The Influence of Infectious Complications in Gastroschisis on Costs and Length of Stay

Abstract

<b>Objective</b> Outcomes for gastroschisis (GS) remain highly variable and avoiding infectious complications (ICs) may represent a significant improvement opportunity. Our objective was to provide estimates of the impact of IC on length of stay (LOS) and costs. <b>Study Design</b> Using a national database, 1,378 patients with GS were identified. Patient and hospital characteristics were compared and LOS and costs evaluated for patients with and without IC. <b>Results</b> Two-thirds of all GS patients had IC, and IC were common for simple and complex GS (65, 73%, respectively). After controlling for patient and hospital factors, LOS in patients with IC was significantly longer than in patients without IC (4.5-day increase, <i>p</i> = 0.001). Specifically, sepsis was associated with increasing median LOS by 11 days (<i>p</i> ≤ 0.001), candida infection by 14 days (<i>p</i> < 0.001), and wound infection by 7 days (<i>p</i> = 0.007). Although overall costs did not differ between patients with and without IC, costs were elevated based on specific IC. Sepsis increased median costs by $22,380 (95% confidence interval [CI]: $14,372–30,388; <i>p</i> ≤ 0.001), wound infection by $32,351 (95% CI: $17,221–47,481; <i>p</i> ≤ 0.001), catheter-related infection by $57,180 (95% CI: $12,834–101,527; <i>p</i> = 0.011), and candida infections by $24,500 (95% CI: $8,832–40,167; <i>p</i> = 0.002). <b>Conclusion</b> IC among GS patients are common and contribute to increased LOS and costs. Quantifying clinical and financial ramifications of IC may help direct future quality improvement efforts.