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Impact on Practice Patterns and Outcomes

Aaron R. Jensen, MD; John H. T. Waldhausen, MD; Stephen S. Kim, MD

Arch Surg. 2009;144(6):516-519.

Objective  To evaluate the impact of the use of a bedside-placed spring-loaded silo (SLS) on practice patterns and on outcomes for infants with gastroschisis.

Design  Retrospective review comparing neonates with gastroschisis treated before and after the implementation of selective SLS placement.

Setting  Tertiary referral center.

Patients  Of 91 consecutive neonates admitted for initial treatment of gastroschisis between January 1998 and August 2007, 45 were admitted before and 46 were admitted after implementation of the SLS.

Main Outcome Measures  Immediate fascial closure rate, infection rate, time to fascial closure, time to initiation of enteral feeding, time to achievement of full enteral feeds, time of hyperalimentation requirement, and length of hospital stay.

Results  The rate of immediate fascial closure was lower in the postimplementation group (58% before vs 20% after implementation, P < .001). Overall length of stay, time to enteral feeding, and infection rates were not significantly different between the 2 groups.

Conclusions  The use of an SLS placed at the bedside has resulted in lower immediate fascial closure rates for infants with gastroschisis without significant detrimental clinical outcome. The main benefit of using the bedside-placed SLS is the avoidance of urgent surgical intervention. For patients undergoing delayed fascial closure, use of the bedside SLS resulted in shorter times to definitive fascial closure.

Author Affiliations: Department of Surgery, University of Washington School of Medicine, Seattle (Drs Jensen, Waldhausen, and Kim); and Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle (Drs Waldhausen and Kim).

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