K. Williams1, L. M. Baumann1, F. Abdullah1,2, R. J. Hendrickson3, T. A. Oyetunji1,2 1Northwestern University,Feinberg School Of Medicine,Chicago, IL, USA 2Ann & Robert H Lurie Children’s Hospital Of Chicago,Pediatric Surgery,Chicago, IL, USA 3Children’s Mercy Hospital- University Of Missouri Kansas City,Kansas City, MO, USA
Introduction: Gastrostomy tube placement is one of the most common procedures performed in the pediatric population. The laparoscopic approach is associated with shorter postoperative length of stay and is increasing in popularity. Single-institution studies have corroborated both the safety and efficacy of early initiation of postoperative feeding using defined pathways, with discharge as early as the first postoperative day. We examined a national database to establish current practice and outcomes as it relates to elective laparoscopic gastrostomy tube placement in children primarily for feeding difficulties.
Methods: We queried the 2012-2013 National Surgical Quality Improvement Program Pediatric (NSQIP-P) database, including all patients who underwent elective laparoscopic gastrostomy tube placement for failure to thrive or feeding difficulties. Only patients who had the procedure performed on the day of admission were selected. Patients who had other procedures on the same admission were excluded, as well as those with other indications for gastrostomy tube placement. Demographic data, admission status, disposition at discharge, surgical subspecialty data and hospital length of stay (LOS) were extracted.
Results: A total of 114,395 patients had laparoscopic gastrostomy placement. After excluding patients who had any other procedures during the admission and keeping only the elective cases, 1486 patients were analyzed. Only 599 gastrostomy tubes were done for failure to thrive or feeding intolerance, the most common indications for gastrostomy tube placement (73%). The majority, 52%, was male and 69.28% were White. The median age was 2.2y (IQR 0.9-6.3). Of the total, 28.7% were infants. Most patients were admitted from home, 96%, and also discharged to home, 95%. Pediatric surgeons performed 96% of gastrostomies and 3.8% were done by general surgeons. Notably, in this elective population, the median total hospital LOS was 2 days (IQR 1-2), with only 39% discharged in a day or less.
Conclusion: Pediatric patients undergoing rather straightforward elective laparoscopic gastrostomy tube placement have a median hospital length of stay of 2 days, despite evidence that early feeding and discharge within 24 hours is both feasible and safe. There is therefore potential for the implementation of an enhanced recovery protocol as a quality metric for this commonly performed procedure in this population. This will result in more efficient healthcare resource utilization without compromising the quality of care.
