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Same-day discharge for pediatric laparoscopic gastrostomy
Charlene Dekonenko1, Wendy Jo Svetanoff1, Obiyo O Osuchukwu1
1Children's Mercy Hospital, Kansas City, MO.
Insights
Same-day discharge (SDD) for pediatric laparoscopic gastrostomy is safe and feasible. This protocol allows select children to go home the same day, reducing hospital admissions and emergency room visits.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Outpatient Care
Background:
- Laparoscopic gastrostomy is a common pediatric surgical procedure.
- A same-day discharge (SDD) protocol was developed for laparoscopic button gastrostomy.
Purpose of the Study:
- To evaluate the safety and feasibility of a same-day discharge protocol for pediatric laparoscopic button gastrostomy.
- To assess admission rates and emergency room visits for children discharged on the same day.
Main Methods:
- Prospective observational study of children undergoing laparoscopic button gastrostomy eligible for SDD.
- Eligibility criteria included family comfort with outpatient surgery, absence of major co-morbidities, no additional procedures requiring admission, and pre-operative education.
- Data collected on patient demographics, operative time, feeding initiation, length of stay, admissions, and post-operative emergency room visits.
Main Results:
- 62 pediatric patients were eligible for the SDD protocol.
- 82% (51 patients) were discharged the same day, with a median length of stay of 9 hours.
- 11 patients (18%) were admitted, most commonly for further teaching. 11 patients visited the ER within 30 days, primarily for mechanical complications.
Conclusions:
- Same-day discharge following laparoscopic gastrostomy is a safe and feasible option for select pediatric patients.
- The SDD pathway is associated with a low rate of hospital admission and a relatively low incidence of post-operative emergency room visits.
Background:
Laparoscopic gastrostomy is a common procedure in children. We developed a same-day discharge (SDD) protocol for laparoscopic button gastrostomy.
Methods:
We performed a prospective observational study of children undergoing laparoscopic button gastrostomy and were eligible for SDD from August 2017-September 2019. Patients were eligible if: 1) the family was comfortable with eliminating overnight admission and were suitable candidates for outpatient surgery (absence of major co-morbidities), 2) they were not undergoing additional procedures requiring admission, and 3) they received pre-operative education.
Results:
Sixty-two patients who underwent laparoscopic button gastrostomy were eligible for SDD. The median age was 2.1 years [IQR 0.9-4.1], and the median weight was 10.5 kg [IQR 7.6-15.5]. Forty-one (66%) were previously nasogastric fed. The median operative time was 22 min [IQR 16-29]. The median time to initiation of feeds was 4.4 h [IQR 3.4-5.5]. Fifty-one (82%) were discharged the same day with a median length of stay of 9 h [IQR 7-10]. Eleven were admitted, most commonly for further teaching. Eleven SDD patients were seen in the emergency room <30 days at a median 5 days [IQR 3-12] post-operatively, primarily for mechanical complications.
Conclusion:
Same-day discharge following laparoscopic gastrostomy is safe and feasible for select pediatric patients who undergo pre-operative education. The SDD pathway results in a low admission rate and relatively low ER visits.
Type Of Study:
Prospective Observational Study.
Level Of Evidence:
Level II.
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