An enhanced recovery after surgery (ERAS) pathway for laparoscopic gastrostomy insertion facilitates 23-h discharge

Enhanced recovery after surgery (ERAS) pathways has become well established for operations as diverse as hip replacement and coronary artery bypass. We designed an ERAS gastrostomy pathway in children based on best practice to facilitate 23-h discharge.

An ERAS pathway for laparoscopic Seldinger gastrostomy insertion was developed in 2018 with standardisation of all phases from first pre-operative visit to discharge. A series of videos uploaded to YouTube accessed via a QR code were created to educate parents. The post-operative feeding regime, nurse-led training and discharge plan were standardised on a single page so it could be shared and viewed easily on a smart phone.

Data were collected prospectively for isolated elective laparoscopic gastrotomy insertion from 2019 to 2022. A total of 155 patients were eligible for the ERAS gastrostomy pathway (median age: 3.9 years; median co-morbidities: 4). Length of post-operative stay was a median 26 h with 60/155 (39%) of patients leaving by 10 am the next morning. Post-operative complications were noted in 20 patients with 6 readmissions none of which were due to early discharge. Multiple non-clinical reasons were identified for delays to discharge.

Multiple major co-morbidities were not a contraindication to following the ERAS. In total, 39% of the patients were discharged by 10 am the next morning. Key to success was having a single surgical technique, standardisation of pre- and post-operative pathways and nurse-led discharge. Further improvements should be possible by closer adherence to the guidelines.