Evaluating Caretaker Satisfaction with Same-Day Discharge after Gastrostomy Tube Placement
Background: Gastrostomy tube (G-tube) placement is among the most common surgical procedures performed in children and is the focus of many quality improvement projects due to disproportionately high pre and postoperative resource utilization resulting in significant cost variability and disparate institutional protocols for perioperative management. With the adoption and success of ERAS type protocols in pediatric surgery, there have been improvements in metrics such as cost, length of stay (LOS), resource utilization, and reduction in opioid use (among other benefits) without increasing morbidity or complications. Although the benefits of these protocols have been established, parental opinions and satisfaction are infrequently addressed. Same-day discharge (SDD) after outpatient laparoscopic gastrostomy tube placement has been our standard institutional practice since 2017, following written and video-based preoperative education regarding G-tube use, maintenance, and exchange, at the time of consultation. We aim to evaluate caretaker satisfaction with this protocol.
Methods: All patients planned for SDD after G-tube placement from February 2021-February 2022 were identified. Chart review was performed to identify demographic information, successful same-day discharge or reason for postoperative admission, time to first postoperative feed, length of stay (LOS), and complications requiring emergency department evaluation, readmission, or reoperation. Telephone followup at two weeks postoperatively was conducted to evaluate satisfaction with the SDD protocol.
Results: Forty-nine patients were eligible for SDD with a median age of 1.1 years [IQR 0.7, 4.4]. Forty-two (86%) patients were successfully discharged the same day with a median LOS of 7.5 hours [6.7, 8.1], and seven (14%) were admitted postoperatively for further education or emesis with a median LOS of 30.4 hours [26.9, 31.2]. Median time to initiation of feeds was 2.3 hours [1.7, 2.9]. Eight (16%) patients were evaluated in the emergency department within 30 days postoperatively, resulting in two readmissions: one for peristomal erythema and fever requiring oral antibiotics at 21 days and one for G-tube dislodgement requiring reoperation and replacement at 28 days. On two-week telephone follow-up, 42 caretakers (100%) felt that their education was adequate for same-day discharge and felt comfortable with the same-day discharge protocol. Six (14%) caretakers stated their child's pain was not well controlled at some point between discharge and survey follow-up, and three caretakers (7%) called a provider within the first 24 hours for issues with pain. Forty-one caretakers (98%) expressed satisfaction going home the day of surgery.
Conclusions: Caretaker satisfaction and comfort with same-day discharge following laparoscopic G-tube placement are high, ascribed to comprehensive preoperative education and anticipatory guidance. Validation of caretaker satisfaction with same-day discharge or expedited discharge protocols should be a necessary component of protocol implementation as there is great value in assessing not only comfort but areas of improvement that are best evaluated by caretakers themselves. As the pediatric surgery community moves towards less resource intense, more cost-efficient practices, including the caretaker perspective in protocol development and implementation is pertinent. Without inquiry of patient and caretaker concerns, evaluation of these protocols should be considered incomplete.
Fraser, MD, James, "Evaluating Caretaker Satisfaction with Same-Day Discharge after Gastrostomy Tube Placement" (2022). Department of Surgery Resident Research Day. Paper 48.