O1097: Giant Omphaloceles – Morbidity, Mortality, and Financial Impact of Early versus Delayed Repair

Background: Omphaloceles are congenital abdominal wall defects characterized by eviscerated abdominal organs contained within a membranous sac. Giant omphaloceles have limited abdominal domain and a significant amount of viscera located extracorporeally. Two commonly utilized methods to repair these defects are primary/staged repair or delayed repair (paint and wrap strategy). We sought to compare the outcomes and financial impact of these treatment strategies over the first two years of life.

Methods: A retrospective review of giant omphaloceles (fascial defect > 5cm or a majority of liver in the omphalocele sac) managed at a tertiary children’s hospital between January 2010 and October 2021 was performed. Survival, length of stay, age at repair, ventilation days (VD), and GI or bronchopulmonary dysplasia (BPD) admissions for those who underwent primary/staged repair (PSR) or delayed repair (DR) were compared in the first two years. Charges for the index and all subsequent hospitalizations during the first two years of life were compared. Charges specifically related to GI morbidity or bronchopulmonary dysplasia (BPD) were also analyzed.

Results: Of the 110 omphaloceles treated over this time period, 34 were giant omphaloceles. Twenty-three underwent DR and 11 PSR (Table.1). As expected, the median age (days) at repair was 302 [163,675] for DR vs 10 [5,21] in the PSR group. Two-year survival was significantly higher in the DR group (95.7% vs 63.6%, p=0.03, Figure 1). The DR group had a higher total number of days hospitalized, both for the index hospitalization and over the two-year period, though not statistically significant. Babies who underwent DR had significantly fewer ventilation days in the initial hospitalization but not over the first two years. There were no statistically significant differences in the total number of admissions, nor in the number of BPD or GI related admissions. The charges for the index hospitalization were similar for the DR and PSR groups. For those that were repaired and survived to 2 years of age, the median total charges for the first two years were 40% higher in the DR group ($1,032,183.80 vs. $729,344.22) but was not statistically significant.

Conclusion: In this retrospective cohort study, primary/staged repair was associated with a higher early mortality. Although delayed repair was associated with lower ventilation days during the index hospitalization, there was no significant difference in total ventilation days or overall morbidity in the first two years. The survival benefit noted with delayed repair may be at the expense of a higher total hospital length of stay and higher total charges over the first two years of life. These findings are useful for patient and family counseling and can aid in surgical decision making. Validation in a large, multicenter study will further strengthen these observations.