K. Zirschky1, N. A. Hamilton1, K. Lofberg1, T. L. Sims1, K. Azarow1 1Oregon Health And Science University,Pediatric Surgery,Portland, OR, USA
Introduction: Clinical practice guidelines, which direct care of medical conditions and performance of clinical procedures, are increasingly common in medicine. However, benefits of clinical guideline implementation for surgical procedures and post-operative care in the pediatric population have not yet been well documented. One area of patient care with significant variability in physician practice is the postoperative management of infants with hypertrophic pyloric stenosis.
Methods: We established clinical practice guidelines for the postoperative care of patients with pyloric stenosis as agreed upon by faculty consensus. A retrospective chart review was designed to evaluate the effects of the implementation of the guidelines. All infants diagnosed with hypertrophic pyloric stenosis at our two major referral children’s hospitals from October 2012 to March 2013 were included in the control group. We allowed for a 6 month period for implementation of the protocol. Those diagnosed with hypertrophic pyloric stenosis from September 2014 to February 2015 were included in the protocol study group. Exclusion criteria for both groups included significant co-morbidities. Charts were reviewed for compliance to the protocol, post-operative complications (as defined by NSQIP), re-admission rates, and length of post-operative hospital stay. The two study groups were then compared using standard statistical analysis, including student t-test to compare the mean length of hospital stay between the control and protocol groups.
Results: There were 41 patients eligible for the study. The control group (n = 24) and protocol group (n = 17) had similar characteristics in terms of age and gender distribution. The mean postoperative hospital stay of the control group and protocol group was 33.81 and 27.43 hours, respectively (p<0.05). No NSQIP complications were noted in either group and there was no significant difference in readmission rate (0 vs 0.05, p=N.S., respectively).
Conclusion:
The implemented guidelines for post-pyloromyotomy care significantly decreased length of hospital stay after surgery without significant impact on complication or re-admission rates.