Timing of pediatric pyloromyotomy on hospital length of stay
Introduction: Pyloromyotomy timing is predicated upon correction of electrolyte abnormalities. Among infants who presented with normal electrolytes, we hypothesized that pyloromyotomy the evening of presentation, rather than waiting until morning, would confer shorter length of stay (LOS). Methods:...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Surgery in Practice and Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666262023000232 |
| _version_ | 1797809815190241280 |
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| author | Faraz N. Longi Audra J. Reiter Shiv Patel Grant Zhao Charesa Smith Seth D. Goldstein Timothy B. Lautz Mehul V. Raval |
| author_facet | Faraz N. Longi Audra J. Reiter Shiv Patel Grant Zhao Charesa Smith Seth D. Goldstein Timothy B. Lautz Mehul V. Raval |
| author_sort | Faraz N. Longi |
| collection | DOAJ |
| description | Introduction: Pyloromyotomy timing is predicated upon correction of electrolyte abnormalities. Among infants who presented with normal electrolytes, we hypothesized that pyloromyotomy the evening of presentation, rather than waiting until morning, would confer shorter length of stay (LOS). Methods: This single-center retrospective cohort study included patients who underwent pyloromyotomy from 2012 to 2021. Exposure was time of operation with nighttime considered between the times of 17:00 and 06:59 and daytime between 07:00 and 16:59. A 2:1 daytime to nighttime match was performed among patients who presented with normal electrolytes with Fisher's Exact and Student's t-test for comparisons. Results: Of 520 patients, 15 (3%) underwent pyloromyotomy overnight and were matched to 30 daytime patients. There were no differences in median age (33 days (interquartile range [IQR] 29–44) vs 32 days (IQR 25–44)), male sex (15 (100%) vs 28 (93.3%), or history of prematurity (0 (0%) vs 2 (6.7%)) for nighttime compared to daytime, respectively. Operative outcomes including conversion to open, duodenal perforation, incomplete myotomy, or surgical site infection did not differ between the groups. While the nighttime group had a significantly shorter time from presentation to operating room (OR) than the daytime group (5.3 vs 15.9 h), there were no significant differences in total LOS (45.7 vs 57.3 h, p = 0.13). Conclusion: For infants with hypertrophic pyloric stenosis who present with normal electrolytes, it is safe to offer operation same-day or following a night of hydration. There was no evidence of improved hospital utilization for patients undergoing pyloromyotomy the night of presentation. |
| first_indexed | 2024-03-13T06:58:29Z |
| format | Article |
| id | doaj.art-ef620c392bf8452ca4aea017a299a611 |
| institution | Directory Open Access Journal |
| issn | 2666-2620 |
| language | English |
| last_indexed | 2024-03-13T06:58:29Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery in Practice and Science |
| spelling | doaj.art-ef620c392bf8452ca4aea017a299a6112023-06-07T04:49:49ZengElsevierSurgery in Practice and Science2666-26202023-06-0113100177Timing of pediatric pyloromyotomy on hospital length of stayFaraz N. Longi0Audra J. Reiter1Shiv Patel2Grant Zhao3Charesa Smith4Seth D. Goldstein5Timothy B. Lautz6Mehul V. Raval7Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesDivision of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesDivision of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesDivision of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesDivision of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesDivision of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesDivision of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesDivision of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Corresponding author at: Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue. Box 63, Chicago, IL 60611, United States.Introduction: Pyloromyotomy timing is predicated upon correction of electrolyte abnormalities. Among infants who presented with normal electrolytes, we hypothesized that pyloromyotomy the evening of presentation, rather than waiting until morning, would confer shorter length of stay (LOS). Methods: This single-center retrospective cohort study included patients who underwent pyloromyotomy from 2012 to 2021. Exposure was time of operation with nighttime considered between the times of 17:00 and 06:59 and daytime between 07:00 and 16:59. A 2:1 daytime to nighttime match was performed among patients who presented with normal electrolytes with Fisher's Exact and Student's t-test for comparisons. Results: Of 520 patients, 15 (3%) underwent pyloromyotomy overnight and were matched to 30 daytime patients. There were no differences in median age (33 days (interquartile range [IQR] 29–44) vs 32 days (IQR 25–44)), male sex (15 (100%) vs 28 (93.3%), or history of prematurity (0 (0%) vs 2 (6.7%)) for nighttime compared to daytime, respectively. Operative outcomes including conversion to open, duodenal perforation, incomplete myotomy, or surgical site infection did not differ between the groups. While the nighttime group had a significantly shorter time from presentation to operating room (OR) than the daytime group (5.3 vs 15.9 h), there were no significant differences in total LOS (45.7 vs 57.3 h, p = 0.13). Conclusion: For infants with hypertrophic pyloric stenosis who present with normal electrolytes, it is safe to offer operation same-day or following a night of hydration. There was no evidence of improved hospital utilization for patients undergoing pyloromyotomy the night of presentation.http://www.sciencedirect.com/science/article/pii/S2666262023000232PyloromyotomyPediatric surgeryLength of staySurgical timing |
| spellingShingle | Faraz N. Longi Audra J. Reiter Shiv Patel Grant Zhao Charesa Smith Seth D. Goldstein Timothy B. Lautz Mehul V. Raval Timing of pediatric pyloromyotomy on hospital length of stay Surgery in Practice and Science Pyloromyotomy Pediatric surgery Length of stay Surgical timing |
| title | Timing of pediatric pyloromyotomy on hospital length of stay |
| title_full | Timing of pediatric pyloromyotomy on hospital length of stay |
| title_fullStr | Timing of pediatric pyloromyotomy on hospital length of stay |
| title_full_unstemmed | Timing of pediatric pyloromyotomy on hospital length of stay |
| title_short | Timing of pediatric pyloromyotomy on hospital length of stay |
| title_sort | timing of pediatric pyloromyotomy on hospital length of stay |
| topic | Pyloromyotomy Pediatric surgery Length of stay Surgical timing |
| url | http://www.sciencedirect.com/science/article/pii/S2666262023000232 |
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