Feeding Advancement and Simultaneous Transition to Discharge (FASTDischarge) after laparoscopic gastrostomy
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In brief
In brief
Retrospective study of 122 pediatric patients demonstrates that early feeding initiation (median 2.8 hours) after laparoscopic gastrostomy is safe and effective, with 97% reaching goal nutrition within 24 hours. The FAST-Discharge protocol achieves median hospital stay of 26 hours without feed-related complications in patients with prior nasogastric tolerance.
Written by the GCMD Library team from the article.
Background
Laparoscopic gastrostomy (LG) is a common surgical procedure. However, there is little consensus on a postoperative feeding regimen. With prior nasogastric feed tolerance, there should be no delay in resumption of feeds and subsequent discharge to home. This is a report on a Feeding Advancement and Simultaneous Transition-Discharge (FAST-Discharge) pathway, which to date has not been reported in the literature.
Methods
A retrospective review of patients who underwent LG was performed from May 2010 to May 2015. All were outpatients who were on prior nasogastric feeds. The postoperative order set initiates feeds in 4 h to advance to goal as tolerated. Time to initial feed and goal nutrition, and overall length of stay (LOS) were evaluated.
Results
122 patients were identified with 55% percent being male and with a median operative age of 15 months (IQR 8–27). 53% were started on bolus feeds. Initial feeds were started at a median of 2.8 h (IQR: 1.8–4.7). The median duration to goal nutrition was 6 h (IQR: 0–14). 97% reached full feeds within 24 h with no complications related to feed advancement. Median LOS was 26 h (IQR: 24–30).
Conclusion
An expedited pathway with early feeding and discharge is possible after laparoscopic gastrostomy tube placement with a low risk for adverse events.
Level of evidence
Level III.