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Should children drink before discharge from day surgery?
M S Schreiner1, S C Nicolson, T Martin
1Children's Hospital of Philadelphia, Pennsylvania 19104-4399.
Insights
Requiring pediatric day surgery patients to drink before discharge did not increase vomiting or readmissions. However, it did prolong their stay in the day surgery unit.
Area of Science:
- Pediatric Anesthesiology and Surgery
- Clinical Outcomes Research
Background:
- Discharge criteria for pediatric day surgery commonly include the ability to tolerate clear liquids without vomiting.
- The impact of this mandatory drinking requirement on patient outcomes and hospital resource utilization is not fully understood.
Purpose of the Study:
- To investigate whether requiring pediatric day surgery patients to drink clear liquids before discharge affects vomiting frequency, discharge timing, or readmission rates for dehydration.
- To compare outcomes between patients with mandatory versus elective drinking criteria.
Main Methods:
- A randomized controlled trial involving 989 pediatric patients (1 month to 18 years) undergoing day surgery.
- Patients were assigned to either a 'mandatory drinkers' group (required to drink before discharge) or an 'elective drinkers' group (drinking allowed but not required).
- All patients received adequate intravenous fluids to cover an 8-hour deficit; other management was identical.
Main Results:
- No significant differences were observed in vomiting incidence in the operating room, postanesthesia care unit, or after discharge between the groups.
- Vomiting occurred in 14% of elective drinkers versus 23% of mandatory drinkers in the day surgery unit (P < 0.001).
- Mandatory drinkers experienced a longer stay in the day surgery unit (101 ± 58 min) compared to elective drinkers (84 ± 40 min) (P < 0.001).
- No patients required hospital admission for vomiting or readmission for vomiting or dehydration.
Conclusions:
- Mandatory clear liquid intake as a discharge criterion for pediatric day surgery does not reduce vomiting or prevent readmissions for dehydration.
- This requirement may unnecessarily prolong the length of stay in the day surgery unit.
- Elective drinking appears to be a safe and potentially more efficient discharge strategy for pediatric day surgery patients.
Abstract:
The ability to drink clear liquids without vomiting after anesthesia and surgery is a commonly used criteria for discharge of pediatric day surgery patients. We hypothesized that the ability to drink as a prerequisite for discharge would not affect the frequency of vomiting, delay discharge, or increase the frequency of readmission of children for dehydration after day surgical procedures. We randomized 989 patients between the ages of 1 month and 18.0 yr to one of two groups. The 464 "mandatory drinkers" were required to demonstrate the ability to drink clear liquids without vomiting prior to discharge from the hospital, whereas 525 "elective drinkers" were allowed but not required to drink. Other than the discharge criteria, the patients were managed in an identical fashion; the minimum volume of intravenous fluids received by all patients was adequate to supply a calculated 8-h fluid deficit prior to discharge from the hospital. There were no differences between the two groups in the incidence of vomiting in the operating room, the postanesthesia care unit, or after discharge from the hospital. However, in the day surgery unit, only 14% of the elective drinkers vomited compared to 23% of the mandatory drinker group (P less than 0.001). The mandatory drinkers had a more prolonged stay in the day surgical unit, averaging 101 +/- 58 min (mean +/- SD) compared to 84 +/- 40 min for elective drinkers (P less than 0.001). No patient in either group required admission to the hospital for persistent vomiting on the day of surgery, and no patient required readmission for vomiting or dehydration after discharge from the day surgery unit.(ABSTRACT TRUNCATED AT 250 WORDS)