Can patient factors predict early discharge after pyloromyotomy?

Because of increased pressure to shorten hospital stays, some advocate discharging patients with pyloric stenosis within four hours of pyloromyotomy. Because some patients have persistent emesis after pyloromyotomy and thus require prolonged hospitalization to prevent dehydration, it would be helpful to be able to predict in which patients this will occur.

We conducted a retrospective review of pyloromyotomies performed within a six-year period to determine whether patient factors could predict length of hospitalization in patients with pyloric stenosis. The study outcome was time to discharge after pyloromyotomy, and the independent variables were patient's age, patient's weight, symptom duration, duration of preoperative hydration, and pyloric length and thickness. Patients were grouped on the basis of time of discharge after pyloromyotomy: <24, 24 to 48, and >48 hours.

Of 230 patients, 58% were discharged within 24 hours, 31% between 24 and 48 hours, and 11% after 48 hours. Patients' weight was inversely proportional to the postoperative length of hospitalization. Conversely, length of time required for preoperative hydration was directly proportional to the duration of postoperative hospitalization.

Patients with lower weight and a longer preoperative hydration period had an increased risk of prolonged hospitalization after pyloromyotomy.