Presenter Status

Fellow

Abstract Type

Research

Primary Mentor

Tolulope Oyetunji

Start Date

9-5-2023 11:30 AM

End Date

9-5-2023 1:30 PM

Presentation Type

Poster-Restricted Access

Description

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.

Objectives/Goal: Our aim was to describe the protocol and subsequent outcomes.

Methods/Design: We conducted a single-center retrospective review of patients diagnosed with HPS from 2016-2020. 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 271 patients. A total of 117 patients (43.2%) had electrolytic disturbances that required fluid boluses in addition to 1.5x maintenance fluids. The median number of lab draws was 2 (IQR 1,2), with a median time from arrival to surgery of 19.2 hours (IQR 15.1,24.9). The median time from surgery to first and full feed was 1.9 hours (IQR 1.2,2.7) and 11.4 hours (IQR 6.2,19.1), respectively. Patients had a median postoperative LOS of 22.2 hours (IQR 9.6,30.6). Re-admission rate within the first 30 postoperative days was 3.3% (n=9) with 2.2% of re-admissions occurring within 72 hours of discharge. One patient required reoperation due to an incomplete pyloromyotomy.

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

Comments

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MeSH Keywords

hypertrophic pyloric stenosis; pyloric stenosis; treatment protocol

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Additional Files

1349-Nelimar Cruz Centeno-abstract.pdf (248 kB)
Abstract

HPS protocol flowchart JSR.jpg (96 kB)
HPS Protocol

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May 9th, 11:30 AM May 9th, 1:30 PM

Hypertrophic Pyloric Stenosis Protocol: A Single Center Study

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.

Objectives/Goal: Our aim was to describe the protocol and subsequent outcomes.

Methods/Design: We conducted a single-center retrospective review of patients diagnosed with HPS from 2016-2020. 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 271 patients. A total of 117 patients (43.2%) had electrolytic disturbances that required fluid boluses in addition to 1.5x maintenance fluids. The median number of lab draws was 2 (IQR 1,2), with a median time from arrival to surgery of 19.2 hours (IQR 15.1,24.9). The median time from surgery to first and full feed was 1.9 hours (IQR 1.2,2.7) and 11.4 hours (IQR 6.2,19.1), respectively. Patients had a median postoperative LOS of 22.2 hours (IQR 9.6,30.6). Re-admission rate within the first 30 postoperative days was 3.3% (n=9) with 2.2% of re-admissions occurring within 72 hours of discharge. One patient required reoperation due to an incomplete pyloromyotomy.

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