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Optimizing throughput of babies with infantile hypertrophic pyloric stenosis
Spencer Wilhelm1, Diane Studzinski1, Hossam Alslaim2
1Corewell Health, William Beaumont University Hospital, Department of Surgery, Royal Oak, MI, USA.
Insights
Same-day surgery for hypertrophic pyloric stenosis (HPS) is feasible for most infants. Afternoon diagnoses commonly delay surgery, increasing hospital length of stay.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Hypertrophic pyloric stenosis (HPS) often experiences delays in definitive surgical care.
- Optimizing preoperative management is crucial for improving care efficiency.
Purpose of the Study:
- To evaluate how modifiable factors in preoperative hypertrophic pyloric stenosis (HPS) management impact care efficiency.
- To identify factors contributing to delayed surgical intervention in HPS patients.
Main Methods:
- Retrospective review of 406 patients who underwent pyloromyotomy for HPS.
- Data collected from two US children's hospitals between 2008 and 2018.
- Analysis of preoperative management and surgical timing.
Main Results:
- 76% of patients were ready for surgery upon emergency room diagnosis.
- Only 43% of patients had surgery on the day of admission.
- Afternoon diagnoses (12 PM - 6 PM) were associated with delayed surgery (next day) compared to morning diagnoses (p < .001).
- Delayed surgery correlated with a longer length of stay (47 hours vs. 32 hours, p < .001).
Conclusions:
- Most hypertrophic pyloric stenosis (HPS) patients can safely undergo same-day surgery.
- Afternoon diagnosis is a common, modifiable factor leading to surgical delays and increased length of stay.
Background:
Definitive surgical care is often delayed in hypertrophic pyloric stenosis (HPS). Our aim is to evaluate the effect modifiable factors in preoperative HPS management have on efficiency of care.
Methods:
A retrospective review of all patients undergoing pyloromyotomy for HPS at two US children's hospitals between 2008 and 2018 was performed.
Results:
406 patients were included in the study. The majority (310, 76 %) were adequately resuscitated and ready for surgery upon diagnosis in the ER. However, only 133 patients (43 %) had surgery on the day of admission. Patients diagnosed between 12pm and 6pm were more likely to have surgery the next day than those diagnosed before noon (67 % vs 33 %, p < .001), which correlated with a longer length of stay (32 vs 47 h, p < .001).
Conclusion:
The majority of patients presenting with HPS can safely undergo same day surgery. Delaying surgery due to an afternoon diagnosis is common, and leads to a modifiable increased total length of stay.
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