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Day-case gastrostomy insertion in children: an achievable reality
David Thompson1, Maddie Allam1, Karen Dick1
1Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
Insights
Day-case gastrostomy insertion is feasible and safe for selected patients, aiming to reduce hospital length of stay. Further pathway modifications may enhance the adoption of this approach for gastrostomy procedures.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes
Background:
- Gastrostomy insertion is a common procedure for nutritional support.
- Reducing length of stay (LOS) is a key goal in optimizing patient care and healthcare resource utilization.
- Day-case gastrostomy (DCG) represents a potential strategy to streamline the gastrostomy insertion process.
Purpose of the Study:
- To evaluate the initial experience and feasibility of day-case gastrostomy (DCG) insertion.
- To assess the safety and outcomes of DCG in a pediatric population.
- To identify factors influencing the successful implementation of DCG.
Main Methods:
- Retrospective review of all primary gastrostomy insertions between April 2018 and April 2024.
- Definition of DCG as patients discharged on the same day of the procedure.
- Collection of demographic, operative, and clinical data, with all cases managed via a standardized feeding pathway.
Main Results:
- Fifteen out of 432 gastrostomies were performed as DCG, with a median age of 3.5 years and a LOS of 12 hours.
- Nutritional supplementation was the most common indication (n=9). Techniques included single-stage percutaneous rapid insertion of gastrostomy button (SPRING) and percutaneous endoscopic gastrostomy (PEG).
- Four minor complications occurred, with two requiring readmission. A significant proportion (8/15) had no prior nasogastric tube feeding experience.
Conclusions:
- Day-case gastrostomy (DCG) is a feasible and safe option for carefully selected patients.
- While most DCGs were performed on morning operating lists, prior nasogastric tube feeding experience was not universal.
- Further modifications to care pathways are recommended to increase the uptake and success of DCG procedures.
Purpose:
Recent efforts have sought to streamline gastrostomy insertion care, particularly length of stay (LOS). We report our initial experience with day-case gastrostomy (DCG) insertion.
Method:
Retrospective review (April 2018-2024) of all primary gastrostomy insertions. Patients discharged the same day as the procedure were defined as DCG. Demographic, operative, and clinical data were recorded. All cases were treated according to a standardized feeding pathway.
Results:
Of 432 gastrostomies formed, 15 were DCG; median age 3.5 (0.7-16.9) years, LOS 12 h (9-15 h). The most common indication was nutritional supplementation (n = 9). Gastrostomy technique was single-stage percutaneous rapid insertion of gastrostomy button (SPRING n = 5) or percutaneous endoscopic gastrostomy (PEG n = 10). Prior to insertion, 6/15 DCG were established on nasogastric (NG) feeding, 8 did not use NG feeding, and 1 had occasional NG feeds. The majority (13/15) were performed on morning operating lists. There were 4 minor complications; 2 required readmission.
Conclusion:
DCG in selected cases is feasible and safe. Most cases were performed on morning operating list, but fewer than half had prior experience of nasogastric tube feeding. We suggest additional pathway modifications to improve DCG uptake.
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