Should children drink before discharge from day surgery?

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.