P0984 - Same-Day Discharge for Pediatric Laparoscopic Gastrostomy

Purpose: Laparoscopic gastrostomy is a common procedure in children. Patients are admitted post-operatively to initiate feeds and perform teaching with family members. We developed a same-day discharge (SDD) protocol for children undergoing laparoscopic button gastrostomy.

Methods: We performed a prospective observational study of children undergoing laparoscopic button gastrostomy and were eligible for SDD from August 2017 to September 2019 was performed. Patients were eligible for SDD if they were not undergoing additional procedures requiring admission or have a planned admission due to medical complexity, and received preoperative gastrostomy button education. Data analysis was performed in STATA with a p<0.05 considered significant.

Results: Sixty-two of 150 patients who underwent laparoscopic 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 hours [IQR 3.4, 5.5]. Fifty-one (82%) were discharged the same day with a median length of stay (LOS) of 9 hours [7, 10], while 11 (18%) were admitted overnight most commonly for further teaching. Eleven SDD patients (21%) were seen in the emergency room within 30 days of surgery compared to 3 patients (27%) who were admitted post-operatively on the day of surgery, p=0.68. The most common reason for emergency room visits was gastrostomy button dislodgement.

Conclusion: Same day discharge following laparoscopic gastrostomy is safe and feasible for select pediatric patients who undergo pre-operative education, with no increase in post-operative emergency room visits compared to overnight hospital stay.