S. N. Acker1, M. Hodges2, T. M. Crombleholme1, S. Somme1, A. M. Kulungowski1, D. A. Partrick1 1Children’s Hospital Colorado,Pediatric Surgery,Aurora, CO, USA 2University Of Colorado,Surgery,Aurora, CO, USA
Introduction: Recent progress has been made in the care of Infants with hypertrophic pyloric stenosis (HPS), including earlier operative intervention and shorter hospital length of stay. This improvement is somewhat attributable to standardized postoperative feeding protocols, which lead to shorter hospital stay. However, these protocols tend to be developed and implemented by surgeons. We hypothesized that patients with HPS admitted to a nonsurgical service postoperatively have longer length of stay (LOS) than those on the floor.
Methods: We reviewed the medical records of infants who underwent pyloromyotomy for HPS at a single institution from 4/09-7/13.
Results: 259 patients underwent pyloromyotomy (35 female; 13.5%), 205 (79%) were admitted to the floor; 47 had a planned NICU admission (18%), and 7 (3%) had an unplanned NICU admission. The groups did not differ in terms of sex, age, electrolytes at presentation, or time between surgeon evaluation and operating room (Table 1). Floor patients had longer preoperative symptom duration (8.5 vs 5.3 days, p=0.02). Operative time was longer in NICU patients (27.2 vs 32 minutes, p<0.01). After excluding those 7 who had an unplanned NICU admission, there was no difference in postoperative apnea or hypoxic episodes; 1 floor and no NICU patients had a bradycardic episode (p=NS). NICU patients had a longer time to full feeds (1.4 vs 2.0 days; p=0001) and longer postoperative LOS (1.6 vs 2.2 days; p=0.0012).
Conclusion: Patients with HPS admitted to the NICU postoperatively had a longer time to full feeds and hospital LOS. This may improve with the implementation of a hospital wide postoperative care protocol to ensure care does not differ between hospital units.