Trends and Outcomes of Same-Day Discharge After Pediatric Laparoscopic Pyloromyotomy

Enhanced recovery after surgery protocols following pediatric pyloromyotomy have been published; however, literature evaluating same-day discharge (SDD) is lacking. This analysis aimed to evaluate SDD outcomes following laparoscopic pyloromyotomy.

The American College of Surgeons National Surgical Quality Improvement Program Pediatrics database (2017-2021) was queried for patients with pyloric stenosis who underwent laparoscopic pyloromyotomy. Preterm infants, patients aged <4 wk or >6 mo, and open operations were excluded. Patients discharged same day postoperatively (SDD) were compared to those discharged 1-2 d postoperatively (non-SDD). Regression analysis was performed.

Of 5851 patients, 367 (6.3%) were SDD. There were significant differences between SDD and non-SDD in weight (4.29 kg versus 4.20 kg; P = 0.035), and operative time (23.30 min versus 29.43 min, P < 0.001). Overall, 34 patients (0.6%) required readmission within 2 d of discharge, with a higher rate in the SDD cohort for emesis (1.1% versus 0.2%; P = 0.012), but no difference in 2-d readmission overall (1.4% versus 0.5%, P = 0.059). There were no significant differences between cohorts for other outcomes. Regression demonstrated American Society of Anesthesiologists (ASA) classes (2-4) increased odds of 30-d readmission (ASA 4: odds ratio 8.89, 95% confidence interval 2.38-33.26, P = 0.001).

Most laparoscopic pyloromyotomy patients are not eligible for SDD; however, it can be reasonable in select patients tolerating feeds with lower ASA classes. SDD results in a 1% increase in early readmission for emesis without an increase in overall readmissions or other complications, which occur at low single-digit percentages.