Same-day discharge for pediatric laparoscopic gastrostomy

Abstract

BackgroundLaparoscopic gastrostomy is a common procedure in children. We developed a same-day discharge (SDD) protocol for laparoscopic button gastrostomy. MethodsWe performed a prospective observational study of children undergoing laparoscopic button gastrostomy and were eligible for SDD from August 2017–September 2019. Patients were eligible if: 1) the family was comfortable with eliminating overnight admission and were suitable candidates for outpatient surgery (absence of major co-morbidities), 2) they were not undergoing additional procedures requiring admission, and 3) they received pre-operative education. ResultsSixty-two patients who underwent laparoscopic button gastrostomy were eligible for SDD. The median age was 2.1 years [IQR 0.9–4.1], and the median weight was 10.5 kg [IQR 7.6–15.5]. Forty-one (66%) were previously nasogastric fed. The median operative time was 22 min [IQR 16–29]. The median time to initiation of feeds was 4.4 h [IQR 3.4–5.5]. Fifty-one (82%) were discharged the same day with a median length of stay of 9 h [IQR 7–10]. Eleven were admitted, most commonly for further teaching. Eleven SDD patients were seen in the emergency room <30 days at a median 5 days [IQR 3–12] post-operatively, primarily for mechanical complications. ConclusionSame-day discharge following laparoscopic gastrostomy is safe and feasible for select pediatric patients who undergo pre-operative education. The SDD pathway results in a low admission rate and relatively low ER visits. Type of studyProspective Observational Study. Level of EvidenceLevel II.