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Minimizing variance in pediatric gastrostomy: does standardized perioperative feeding plan decrease cost and improve
Rachel Sunstrom1, Nicholas Hamilton1, Elizabeth Fialkowski1
1Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Insights
Implementing a laparoscopic gastrostomy protocol reduced hospital length of stay without impacting patient outcomes or increasing costs. This standardized approach to gastrostomy tube management is achievable and effective.
Area of Science:
- Surgical Procedures
- Healthcare Management
- Patient Outcomes
Background:
- A protocol for laparoscopic gastrostomy placement was implemented, detailing perioperative antibiotics, feeding regimens, and discharge criteria.
- The study hypothesized that this protocol could decrease hospital costs while maintaining or improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of a standardized laparoscopic gastrostomy protocol on hospital costs and patient outcomes.
- To assess surgeon compliance with the implemented protocol.
Main Methods:
- Data collected on consecutive patients post-protocol implementation compared to a 6-month historical control period.
- Evaluated surgeon compliance, 30-day patient complication rates (NSQIP), and initial hospitalization costs.
Main Results:
- Shorter length of stay observed in the protocol group (n=39) compared to the control group (n=26).
- Similar complication rates between groups (15% protocol vs. 23% control).
- No significant difference in initial hospital costs; surgeon compliance was 82%.
Conclusions:
- A standardized protocol for gastrostomy tube management is feasible.
- The implemented protocol significantly decreased length of stay while maintaining patient quality.
Background:
A protocol for laparoscopic gastrostomy placement was implemented which specified perioperative antibiotics, feeding regimens, and discharge criteria. Our hypothesis was that hospital cost could be decreased, whereas at the same time improving or maintaining patient outcomes.
Methods:
Data were collected on consecutive patients beginning 6 months after implementation of our protocol. We recorded surgeon compliance, patient outcomes (as defined by 30-day NSQIP complication rates), and cost of initial hospitalization, which was then compare to a 6-month historical control period.
Results:
Our control group n = 26 and protocol group n = 39. Length of stay was shorter in the protocol group (P ≤ .05 by nonparametric analysis). The complication rate was similar in both groups (23% control vs 15% protocol, P = .43). Initial hospital costs were not different. Surgeon compliance to protocol was 82%.
Conclusions:
A standard protocol is achievable for gastrostomy tube management. After implementation of our protocol, we were able to show a significant decrease in length of stay, whereas maintaining quality.
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