Same-Day Discharge for Elective Pediatric Laparoscopic Gastrostomy Tube Insertion is Safe and Increasing in Frequency; A NSQIP Pediatric Retrospective Review 2017 to 2021
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Topic Overview
Background: There 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.
Methods: ACS NSQIP-P registry data from 2017 to 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.
Results: There 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%–4.8% to 4.5%–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.
Conclusion: Though 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.
Transcript
What if the trends and outcomes have samed the discharge after a pediatric elective laparoscopic gastroastomy? I'm Alex Halpern, a research fellow from Children's National, and this is an article that you should know. Woodward at all performed a retrospective analysis of the ACS Nesquip P database from 2017 to 2021 to try and answer this question. They identified 5,947 pediatric patients who underwent elective laparoscopic gastroastomy to placement. 4.7% of those patients were discharged the same day. Through a not significant difference in 30-day unplanned readmissions, re-operations, or any other complications between the patients discharged the same day, and those discharge in one to two days postoperatively. So it seems like same-day discharge for pediatric patients after elective laparoscopic gastroastomy is safe, but not commonly done. Does this information change your practice at all? Let us know what you think in the comments below.