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Minimizing hospital length of stay in children undergoing ureteroneocystostomy
1Department of Surgery, University of Tennessee Medical Center at Knoxville, 37920-6999, USA.
Insights
Ketorolac tromethamine and early bladder catheter removal significantly shorten hospital stays for pediatric ureteroneocystostomy patients. This approach reduces costs without compromising care quality.
Area of Science:
- Pediatric Surgery
- Urology
- Pain Management
Background:
- Surgical correction of vesicoureteral reflux (VUR) in children aims to reduce hospital stay and costs.
- Optimizing postoperative care is crucial for efficient pediatric surgical recovery.
Purpose of the Study:
- To evaluate the impact of ketorolac tromethamine versus narcotics on postoperative pain management.
- To determine the effect of early bladder catheter removal on hospital length of stay in pediatric ureteroneocystostomy.
Main Methods:
- Retrospective review of 43 pediatric patients undergoing ureteroneocystostomy.
- Comparison of postoperative pain management using intravenous ketorolac tromethamine versus narcotics.
- Analysis of hospital stay duration based on bladder catheter removal time (less than or greater than 24 hours).
Main Results:
- Patients receiving ketorolac experienced shorter hospital stays (1.4 days) compared to those on narcotics (2.5 days).
- Early bladder catheter removal (within 24 hours) also resulted in significantly shorter hospital stays (1.4 days vs. 2.4 days).
- No reimplantation failures were reported; one patient had mild anemia postoperatively.
Conclusions:
- Ketorolac tromethamine is a safe and effective option for immediate postoperative analgesia in children.
- Early bladder catheter removal, combined with appropriate analgesia, can effectively reduce hospital length of stay for pediatric ureteroneocystostomy.
- These findings support strategies for cost savings in pediatric VUR surgery.
Objectives:
Shortening hospital stay yet not compromising quality of care can result in significant cost savings for children undergoing surgical correction of vesicoureteral reflux.
Methods:
We reviewed the medical records of pediatric patients who underwent ureteroneocystostomy between July 1995 and July 1997. A total of 43 patients, aged 0.2 to 18 years (mean 5.2) who all received identical postoperative care, except for their pain management and the time of bladder catheter removal, were included in the study. Twenty-three were treated with intravenous ketorolac tromethamine (Toradol); the remaining 20 received narcotics in the immediate postoperative period. The bladder catheter was removed in less than 24 hours in 22 children, and greater than 24 hours in 21.
Results:
Patients who received ketorolac tromethamine for postoperative analgesia had on average shorter hospital length of stays than those treated with narcotics (1.4 versus 2.5 days, respectively; P < 0.001). The average stay for children whose bladder catheter was removed within 24 hours postoperatively was significantly shorter than those whose catheter was removed after a 24-hour period (1.4 versus 2.4 days, respectively; P < 0.001). There were no reimplantation failures. One child presented 2 days postoperatively with anemia, which did not require transfusion.
Conclusions:
Our review demonstrates that ketorolac tromethamine can be used safely and effectively in children for immediate postoperative analgesia, and that its proper use combined with early catheter removal can reduce the length of hospital stay for pediatric patients undergoing ureteroneocystostomy.