Objective A recent publication has suggested that expedited time to theater in gastroschisis results in higher rates of primary closure and decreases the length of stay (LOS). This study primarily aims to assess the impact of time to first management of neonates with gastroschisis on the LOS. Methods Neonates admitted between August 2013 and August 2020 with gastroschisis were included. Data were collected retrospectively, and neonates with complex gastroschisis were excluded. Variables including gestation, birth weight, time of first management, primary/delayed closure and use of patch were evaluated as possible confounding variables. The outcome measures were time to full feeds, time on parenteral nutrition (PN) and LOS. Univariate and multivariate linear regression analyses were performed. P<0.05 was regarded as significant. Results Eighty-six neonates were identified, and 16 were then excluded (eight patients with complex gastroschisis, eight patients with time to first management not documented). The median LOS for those who underwent primary closure was 21 days (interquartile range (IQR) =16–29) and for those who underwent silo placement and delayed closure was 59 days (IQR=44–130). The mean time to first management was 473 min (standard deviation (SD) =146 min), with only 20% of these infants being operated on at less than 6 hours of age. Univariate and multivariate analyses demonstrated no relationship between time to first management and LOS (r2=0.00, p=0.82) but did demonstrate a consistent positive association between time to first feed and LOS and delayed closure, resulting in a longer time to full feeds and a longer time on PN. Conclusions The time to first management was not associated with a change in LOS in these data. Further prospective evaluation of the impact of reducing the time to first feed on the LOS is recommended. Level of evidence IV. Data are available upon reasonable request.

中文翻译：

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对于单纯性腹裂，就诊时间重要吗？

目的 最近的一篇出版物表明，腹裂患者加快到达手术室的时间会导致较高的一期闭合率并缩短住院时间 (LOS)。本研究的主要目的是评估腹裂新生儿首次治疗时间对 LOS 的影响。方法纳入2013年8月至2020年8月收治的腹裂新生儿。回顾性收集数据，排除患有复杂性腹裂的新生儿。包括妊娠、出生体重、首次处理时间、初次/延迟闭合和贴剂使用在内的变量被评估为可能的混杂变量。结果指标是全喂食时间、肠外营养时间 (PN) 和 LOS。进行单变量和多变量线性回归分析。P<0.05被认为是显着的。结果 确定了 86 名新生儿，然后排除 16 名（8 名患有复杂腹裂的患者，8 名未记录首次治疗时间的患者）。接受初步关闭的患者的中位 LOS 为 21 天（四分位距 (IQR) = 16–29），而接受筒仓放置和延迟关闭的患者的中位 LOS 为 59 天（IQR=44–130）。首次处理的平均时间为 473 分钟（标准差 (SD) = 146 分钟），其中只有 20% 的婴儿在出生后 6 小时内接受手术。单变量和多变量分析表明，首次管理时间与 LOS 之间没有关系（r2=0.00，p=0.82），但确实表明首次饲喂时间与 LOS 和延迟关闭之间存在一致的正相关关系，导致完全饲喂时间更长，并且PN 上的时间较长。结论 在这些数据中，首次管理时间与 LOS 变化无关。建议进一步前瞻性评估缩短首次进食时间对 LOS 的影响。证据级别 IV. 数据可根据合理要求提供。