Same-day discharge for pediatric laparoscopic gastrostomy.
BACKGROUND: Laparoscopic gastrostomy is a common procedure in children. We developed a same-day discharge (SDD) protocol for laparoscopic button gastrostomy.
METHODS: We performed a prospective observational study of children undergoing laparoscopic button gastrostomy and were eligible for SDD from August 2017-September 2019. Patients were eligible if: 1) the family was comfortable with eliminating overnight admission and were suitable candidates for outpatient surgery (absence of major co-morbidities), 2) they were not undergoing additional procedures requiring admission, and 3) they received pre-operative education.
RESULTS: Sixty-two patients who underwent laparoscopic button gastrostomy were eligible for SDD. The median age was 2.1 years [IQR 0.9-4.1], and the median weight was 10.5 kg [IQR 7.6-15.5]. Forty-one (66%) were previously nasogastric fed. The median operative time was 22 min [IQR 16-29]. The median time to initiation of feeds was 4.4 h [IQR 3.4-5.5]. Fifty-one (82%) were discharged the same day with a median length of stay of 9 h [IQR 7-10]. Eleven were admitted, most commonly for further teaching. Eleven SDD patients were seen in the emergency room[IQR 3-12] post-operatively, primarily for mechanical complications.
CONCLUSION: Same-day discharge following laparoscopic gastrostomy is safe and feasible for select pediatric patients who undergo pre-operative education. The SDD pathway results in a low admission rate and relatively low ER visits.
TYPE OF STUDY: Prospective Observational Study.
LEVEL OF EVIDENCE: Level II.
Journal of pediatric surgery
Button gastrostomy; Laparoscopic gastrostomy; Same-day surgery
Dekonenko, C., Svetanoff, W., Osuchukwu, O. O., Pierce, A. L., Orrick, B. A., Sayers, K. L., Rentea, R. M., Aguayo, P., Fraser, J. D., Juang, D., Hendrickson, R. J., Snyder, C. L., Andrews, W. S., St Peter, S. D., Oyetunji, T. A. Same-day discharge for pediatric laparoscopic gastrostomy. Journal of pediatric surgery 56, 26-29 (2021).