Same-Day Discharge for Elective Pediatric Laparoscopic Gastrostomy Tube Insertion is Safe and Increasing in Frequency; a NSQIP Pediatric Retrospective Review 2017 to 2021

Abstract

BackgroundThere is limited literature reviewing same-day discharge for elective pediatric gastrostomy tube placement. Our aim was to assess the outcomes and national trends of same-day discharge following elective pediatric laparoscopic gastrostomy. MethodsACS NSQIP-P registry data from 2017 – 2021 was used to evaluate elective pediatric laparoscopic gastrostomy patients who presented from home and discharged home with a diagnosis of failure to thrive, feeding difficulty or dysphagia. Patients discharged same-day postoperatively (SDD) were compared to those discharged 1-2 days postoperatively (non-SDD) for the primary outcome of unplanned 30-day readmission. Secondary outcomes included bleeding events, wound infection, and 30-day reoperation. ResultsThere were 5,947 patients identified; 4.7% were discharged same-day. The annual rate of SDD over 5 years went from 2.7% to 4.6% to 4.8% to 4.5% to 6.3%. There were no significant differences between SDD and non-SDD patients for early readmission or reoperation (0.7% vs 0.3%, p=0.279), 30-day unplanned readmission (8.5% vs 8.0%, p=0.407), reoperation (0.1% vs 1.4%, p=1.000), or any other complications (p>0.05). Binary logistic regression found pre-operative steroid use within 30 days increased risk of serious complication (OR 2.02, 95% CI 1.29-3.15, p=0.002) and 30-day readmission or reoperation (OR 2.10, 95% CI 1.34-3.27, p=0.001). All 6 patients (0.1%) who required reoperation within 3 days were identified prior to discharge, and none of the 16 patients readmitted within 3 days of surgery required reoperation. ConclusionThough rates of same-day discharge following pediatric gastrostomy tube placement are low, they continue to increase annually. There were no significant differences in outcomes between same-day and non-same-day day discharge for elective cases presenting from and discharging home. In non-steroid using patients, same-day discharge following laparoscopic gastrostomy can be a safe option. Level of Evidence (I-V)Level III