Abstract
Background
Same-day discharge (SDD) after laparoscopic gastrostomy tube (G-tube) placement, using
written and video-based preoperative education, has been our standard institutional
practice since 2017. We aim to evaluate caretaker satisfaction with this protocol.
Methods
All patients planned for SDD after G-tube placement from February 2021-February 2022
were identified. Chart review was performed to identify demographic information, successful
same-day discharge or reason for postoperative admission, time to first postoperative
feed, length of stay (LOS), and complications requiring emergency department evaluation,
readmission, or reoperation. Telephone follow-up at two weeks postoperatively was
conducted to evaluate satisfaction with the SDD protocol.
Results
Forty-nine patients were eligible for SDD with a median age of 1.1 years [0.7, 4.4].
Forty-two (86%) patients were successfully discharged the same day with a median LOS
of 7.5 h [6.7, 8.1], and 7 (14%) were admitted postoperatively for further education
or emesis with a median LOS of 30.4 h [26.9, 31.2]. Median time to initiation of feeds
was 2.3 h [1.7, 2.9]. 8 (16%) patients were evaluated in the emergency department
within 30 days postoperatively, resulting in two re-admissions: one for peri‑stomal
erythema and fever requiring oral antibiotics at 21 days and one for G-tube dislodgement
requiring reoperation and replacement at 28 days. On two-week telephone follow-up,
42 caretakers (100%) felt that their education was adequate for same-day discharge
and felt comfortable with the same-day discharge protocol. Six (14%) caretakers stated
their child's pain was not well controlled at some point between discharge and survey
follow-up, and three caretakers (7%) called a provider within the first 24 h for issues
with pain. Forty-one caretakers (98%) expressed satisfaction going home the day of
surgery.
Conclusion
Caretaker satisfaction and comfort with same-day discharge following laparoscopic
G-tube placement are high, ascribed to comprehensive preoperative education and anticipatory
guidance.
Type of study
Prognostic.
Level of evidence
Level 1.
Keywords
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References
- The effect of standardized discharge instructions after gastrostomy tube placement on postoperative hospital utilization.J Pediatr Surg. 2021; 57: 418-423https://doi.org/10.1016/j.jpedsurg.2021.03.045
- Resource utilization after gastrostomy tube placement: defining areas of improvement for future quality improvement projects.J Pediatr Surg. 2014; 49: 1598-1601https://doi.org/10.1016/j.jpedsurg.2014.06.015
- Resource utilization after implementing a hospital-wide standardized feeding tube placement pathway.J Pediatr Surg. 2016; 51: 1674-1679https://doi.org/10.1016/j.jpedsurg.2016.05.012
- Minimizing variance in pediatric gastrostomy: does standardized perioperative feeding plan decrease cost and improve outcomes?.Am J Surg. 2016; 211: 948-953https://doi.org/10.1016/j.amjsurg.2016.02.004
- Examining length of stay after commonly performed surgical procedures in ACS NSQIP pediatric.J Surg Res. 2018; 231: 186-194https://doi.org/10.1016/j.jss.2018.05.054
- Elective laparoscopic gastrostomy in children: potential for an enhanced recovery protocol.Pediatr Surg Int. 2019; 35: 643-647https://doi.org/10.1007/s00383-019-04472-7
- Implementation of a gastrostomy care bundle reduces dislodgements and length of stay.J Pediatr Surg. 2021; 56: 30-36https://doi.org/10.1016/j.jpedsurg.2020.09.045
- Same-day discharge for pediatric laparoscopic gastrostomy.J Pediatr Surg. 2021; 56: 26-29https://doi.org/10.1016/j.jpedsurg.2020.09.044
- Feeding advancement and simultaneous transition to discharge (FASTDischarge) after laparoscopic gastrostomy.J Pediatr Surg. 2018; 53: 2326-2330https://doi.org/10.1016/j.jpedsurg.2018.04.035
- Pediatric gastrostomy tube placement: lessons learned from high-performing institutions through structured interviews.Pediatr Qual Saf. 2017; 2: e016https://doi.org/10.1097/pq9.0000000000000016
- Why wait: early enteral feeding after pediatric gastrostomy tube placement.J Pediatr Surg. 2018; 53: 656-660https://doi.org/10.1016/j.jpedsurg.2017.06.015
- Postoperative feeding regimens after laparoscopic gastrostomy placement.J Laparoendosc Adv Surg Tech A. 2017; 27: 1203-1208https://doi.org/10.1089/lap.2017.0295
- Implementation and outcomes of enhanced recovery protocols in pediatric surgery: a systematic review and meta-analysis.Pediatr Surg Int. 2022; 38: 157-168https://doi.org/10.1007/s00383-021-05008-8
- Embracing change: the era for pediatric ERAS is here.Pediatr Surg Int. 2019; 35: 631-634https://doi.org/10.1007/s00383-019-04476-3
- Application of enhanced recovery after surgery during the perioperative period in infants with Hirschsprung's disease – a multi-center randomized clinical trial.Clin Nutr. 2020; 39: 2062-2069https://doi.org/10.1016/j.clnu.2019.10.001
- What is the role of enhanced recovery after surgery in children? A scoping review.Pediatr Surg Int. 2017; 33: 43-51https://doi.org/10.1007/s00383-016-3986-y
- Fast-track surgery in infants and children.J Pediatr Surg. 2007; 42: 234-238https://doi.org/10.1016/j.jpedsurg.2006.09.022
- Fast- track concepts in routine pediatric surgery: a prospective study in 436 infants and children.Langenbeck's Arch Surg. 2009; 394: 529-533https://doi.org/10.1007/s00423-008-0440-1
- Feasibility of fast-track elements in pediatric surgery.Eur J Pediatr Surg. 2012; 22: 40-44https://doi.org/10.1055/s-0031-1284422
- Implementation of fast-track pediatric surgery in a German nonacademic institution without previous fast-track experience.Eur J Pediatr Surg. 2014; 24: 419-425https://doi.org/10.1055/s-0033-1352528
Article info
Publication history
Published online: September 24, 2022
Accepted:
September 16,
2022
Received:
August 26,
2022
Footnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
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