(258) Implementation and outcomes of a stratified patient post-operative relocation protocol after fetoscopic spina bifida repair

Objective: In utero spina bifida repair has been shown to improve neonatal outcomes. Traditionally, antenatal repair requires patient relocation resulting in additional patient financial burden and disruption of family units. In 2021, we developed a protocol for post-operative assessment and safe patient relocation home with support of local institutions. Our primary objective was to assess the perinatal outcomes of this approach to patient centered care.

Study Design: This study is a post-implementation analysis of a protocol for patient assessment and relocation after fetoscopic spina bifida repair at our fetal center from 4/2021-7/2023. After surgical recovery, patients followed up at our fetal center for 2 weeks undergoing post-operative assessment and antenatal testing. Patients were then notified if relocation to a home institution was advisable. Clinically relevant outcomes were obtained from electronic medical records.

Results: During the 2-year study period, 71 patients underwent fetoscopic spina bifida repair at our fetal center. Surgical gestational age was 25 ±1 weeks with an average 4 ±1 days post operative stay. Following planned 2-week evaluation, 81% (58/71) of patients met criteria to return home, 38% (22/58) elected to deliver at our fetal center while 47% (27/58) delivered at their local institution. 18.3% (13/71) did not meet criteria for relocation and 9 patients were undelivered at time of study assessment. The average gestational age at delivery (37 [35, 38] vs 36 [34, 39] wk, p=0.54), rates of premature rupture of membranes (32% vs 33%, p=1.0), abruption (0% vs 7%, p=0.49) and vaginal delivery (45% vs 52%, p=0.78) were similar. Neonatal birthweight (2870 ± 425g vs 2670 ± 609g, p=0.18) and NICU stay (14 ± 11 vs 16 ± 20 days, p=0.45) were equivalent.

Conclusion: Our study shows the feasibility of implementing a standardized protocol for patient relocation home after fetoscopic spina bifida repair with equivalent perinatal outcomes. This approach provides an evidence-based, patient-centered and collaborative approach to fetal care while focusing on patient desires and optimal outcomes.