Impact of Standardized Postoperative Feeding Regimen After Laparoscopic Pyloromyotomy Utilizing a Computerized Provider Order Entry Order Set

Abstract

Credits: Study data were collected and managed using REDCap electronic data capture tools hosted at the Children’s Foundation Research Institute - Biomedical Informatics Core and the University of Tennessee Health Science Center (Harris et al., 2009). Research Electronic Data Capture is a secure, Web-based application designed to support data capture for research studies, providing (a) an intuitive interface for validated data entry, (b) audit trails for tracking data manipulation and export procedures, (c) automated export procedures for seamless data downloads to common statistical packages, and (d) procedures for importing data from external sources. Introduction Various feeding regimens are used for infants after pyloromyotomy for hypertrophic pyloric stenosis (HPS). A few studies have shown that standardized feeding regimens (SFRs) can decrease length of hospital stay. In January 2010, a freestanding academic children’s hospital converted to Computerized Provider Order Entry (CPOE), and standard order sets were implemented. A postoperative order set was devised for patients with HPS, and an SFR was specified. Purpose The aim of this study was to measure impact of a CPOE-driven SFR on postoperative length of stay (LOS) after laparoscopic pyloromyotomy. Methods A retrospective review of patients admitted with HPS who underwent laparoscopic pyloromyotomy from July 2007 to October 2009 (pre-CPOE) and from April 2010 to July 2012 (post-CPOE) at a free-standing academic children’s hospital was conducted. LOS was defined as the time from surgery to time discharge orders were written. Results There was no difference in the LOS between the pre- and post-CPOE groups. There was also no difference in the time from surgery to time discharge criteria were met between the two groups. No differences in frequency of emesis, 30-day readmit, or complication rates were seen. Physician compliance to use of CPOE SFR was 99.3%. Conclusions Design and implementation of a CPOE order set for the postoperative care of patients after pyloromyotomies utilizing an SFR did not impact the postoperative LOS. However, it can be used to produce consistent care without significantly increasing complication rates or 30-day readmits.