Hypertrophic Pyloric Stenosis Protocol: A Single Center Study.

Creator(s)

Nelimar Cruz-Centeno, Children's Mercy Kansas City
James Fraser, Children's Mercy HospitalFollow
Shai Stewart, Children's Mercy Kansas City
Derek Marlor, Children's Mercy Kansas CityFollow
Rebecca M. Rentea, Children's Mercy HospitalFollow
Pablo Aguayo, Children's Mercy HospitalFollow
David Juang, Children's Mercy HospitalFollow
Richard J. Hendrickson, Children's Mercy HospitalFollow
Charles L. Snyder, Children's Mercy HospitalFollow
Shawn D. St Peter, Children's Mercy HospitalFollow
Jason D. Fraser, Children's Mercy HospitalFollow
Tolulope A. Oyetunji MD MPH, Children's Mercy Kansas CityFollow

Document Type

Article

Publication Date

12-2023

Identifier

DOI: 10.1177/00031348231175126

Abstract

BACKGROUND: Initial treatment of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Our aim was to describe the protocol and subsequent outcomes.

METHODS: We conducted a single-center retrospective review of patients diagnosed with HPS from 2016 to 2023. All patients were given ad libitum feeds postoperatively and discharged home after tolerating three consecutive feeds. The primary outcome was the postoperative hospital length of stay (LOS). Secondary outcomes included the number of preoperative labs drawn, time from arrival to surgery, time from surgery to initiation of feeds, time from surgery to full feeds, and re-admission rate.

RESULTS: The study included 333 patients. A total of 142 patients (42.6%) had electrolytic disturbances that required fluid boluses in addition to 1.5x maintenance fluids. The median number of lab draws was 1 (IQR 1,2), with a median time from arrival to surgery of 19.5 hours (IQR 15.3,24.9). The median time from surgery to first and full feed was 1.9 hours (IQR 1.2,2.7) and 11.2 hours (IQR 6.4,18.3), respectively. Patients had a median postoperative LOS of 21.8 hours (IQR 9.7,28.9). Re-admission rate within the first 30 postoperative days was 3.6% (n = 12) with 2.7% of re-admissions occurring within 72 hours of discharge. One patient required re-operation due to an incomplete pyloromyotomy.

DISCUSSION: This protocol is a valuable tool for perioperative and postoperative management of patients with HPS while minimizing uncomfortable intervention.

Journal Title

The American surgeon

Volume

89

Issue

12

First Page

5697

Last Page

5701

MeSH Keywords

Humans; Infant; Pyloric Stenosis, Hypertrophic; Enteral Nutrition; Fluid Therapy; Retrospective Studies; Length of Stay

Keywords

gastrointestinal; pediatric surgery; protocol, outcomes; pyloric stenosis

Recommended Citation

Cruz-Centeno N, Fraser JA, Stewart S, et al. Hypertrophic Pyloric Stenosis Protocol: A Single Center Study. Am Surg. 2023;89(12):5697-5701. doi:10.1177/00031348231175126