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Can standard open pediatric urological procedures be performed on an outpatient basis?
J K Sprunger1, C T Reese, R M Decter
1Division of Urology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA.
Insights
Standard open pediatric urological procedures are feasible on an outpatient basis. This approach maintains patient safety and satisfaction while reducing healthcare costs.
Area of Science:
- Pediatric Urology
- Outpatient Surgery
- Patient Safety
Background:
- The current healthcare climate emphasizes cost-effectiveness.
- There is a need to evaluate the feasibility of outpatient pediatric urological procedures.
Purpose of the Study:
- To determine if standard open pediatric urological procedures can be safely and effectively performed on an outpatient basis.
- To assess patient satisfaction with outpatient pediatric urological surgery.
Main Methods:
- A retrospective review of 51 pediatric patients (2 months to 13 years) undergoing open urological procedures.
- Procedures included ureteral reimplantation, pyeloplasty, and nephrectomy.
- Outpatient management was discussed preoperatively; caudal blocks and wound infiltration were used for analgesia.
Main Results:
- 86% of patients (44 out of 51) were discharged the same day of surgery.
- Average postoperative hospitalization was 7 hours.
- No major complications or repeat hospitalizations occurred; one patient required catheterization.
Conclusions:
- Standard open pediatric urological procedures can be safely performed on an outpatient basis.
- Outpatient surgery is a viable option for pediatric urology, ensuring patient comfort and safety.
Purpose:
We questioned whether it is feasible in the current era of cost consciousness to perform standard open pediatric urological procedures on an outpatient basis while maintaining patient safety and satisfaction.
Materials And Methods:
We report on 51 consecutive patients 2 months to 13 years old (mean age 4 years 3 months) who underwent a standard open pediatric urological procedure between August 1999 and June 2000. The procedures included ureteral reimplantation in 22 cases (tapered in 2), pyeloplasty in 20, partial nephrectomy in 2, nephrectomy in 2, complete ureterocele reconstruction in 1 and other in 4. The expectation that the procedure would be performed on an outpatient basis was discussed with parents preoperatively. We excluded only cases requiring bowel for reconstruction. A caudal block was administered at the start of the procedure using 0.25% bupivacaine with 1:200,000 epinephrine at a dose of 1 cc/kg. The wound was infiltrated with 1 cc/kg. 0.25% bupivacaine and 0.5 mg./kg. ketorolac was administered at the end of the procedure. As soon as the child awakened, an age appropriate diet was started and 0.5 to 1 mg./kg. codeine with acetaminophen was given every 4 hours.
Results:
Of the 51 children 44 (86%) were discharged home the day of surgery. Average postoperative hospitalization was 7 hours. One of the 44 children discharged home required a single catheterization elsewhere. There were no other complications or repeat hospitalizations.
Conclusions:
Our experience shows that standard open pediatric urological procedures may be performed safely and comfortably on an outpatient basis.
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