Application of multidisciplinary treatment and Double Sinks policy during enhanced recovery after surgery for perioperative management of congenital hypertrophic pyloric stenosis

Abstract

Objective To evaluate the application of multidisciplinary treatment (MDT) and Double Sinks (DS, top-down hospital & talent services) policy during enhanced recovery after surgery (ERAS) for perioperative management of congenital hypertrophic pyloric stenosis (CHPS). Methods From January 2015 to December 2018, a total of 230 CHPS infants received traditional model (traditional group, n=178) and ERAS model (ERAS group, n=52) during perioperative management. Age at admission, time of disease course, nutritional status, incidence of preoperative respiratory infection, blood gas electrolyte analysis at admission, preoperative length of stay, leucocyte counts (WBC) and C-reactive protein (CRP) at postoperative Day 1, postoperative length of stay, hospitalization expenses and age at discharge were recorded and compared. Results Age at admission [(32.9±8.4) vs. (41.4±18.2) days], total length of stay [(9.2±5.0) vs. (13.7±10.8) days], incidence of preoperative respiratory infection [3.85% vs. 15.19%], preoperative length of stay [(3.91±1.13) vs. (7.21±2.81) days], postoperative length of stay [(3.91±1.13) vs. (7.21±2.81) days], hospitalization expenses [(11 290.13±1 725.19) vs. (14 676.21±4 620.72) RMB] and age at discharge [(39.4±9.6) vs. (52.4±18.2) days] in ERAS group were superior to those in traditional group and there were significant inter-group differences (P≤0.001 or <0.05). No significant inter-group difference existed in WBC/CRP at postoperative Day 1. MDT and DS were co-correlated with age at admission (-0.273, P<0.001), preoperative length of stay (0.324, P<0.001), postoperative length of stay (0.205, P=0.006), hospitalization expenses (0.399, P<0.001) and age at discharge (-0.201, P=0.007). Conclusions ERAS model may promote postoperative recovery and reduce hospitalization expenses. And MDT helps to shorten preoperative length of stay and DS may reduce age at admission and lower the incidence of preoperative respiratory infection. Both are indispensable and important components of ERAS measures during perioperative management of infantile CHPS. Key words: Pyloric Stenosis, Hypertrophic; Perioperative care; Enhanced recovery after surgery