A standardized feeding regimen for hypertrophic pyloric stenosis decreases length of hospitalization and hospital costs

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Abstract

Background/Purpose: Before the institution of a standardized feeding regimen (SFR) for hypertrophic pyloric stenosis (HPS) at the authors' institution, the postoperative feeding regimen and, thus, the length of hospitalization for HPS patients was variable. The aim of this study was to evaluate whether a SFR would affect the length of hospitalization or hospital costs for HPS patients. Methods: A 5-year retrospective analysis was performed on 242 patients who underwent pyloromyotomy via a standard right upper quadrant incision. The length of hospitalization and hospital costs were compared in these patients before and after the institution of a standardized postoperative feeding regimen. Results: The SFR decreased total length of hospitalization by 19.4% (3.1 days v 2.5 days, P =.002), postoperative length of stay by 21% (1.9 days v 1.5 days, P <.001), total costs by 11.9% (P =.05), direct costs by 7.7% (P =.22), and indirect costs by 18.6% (P =.003). This occurred despite a small increase in costs per day. The SFR did not change the complication rate (5.3% before SFR v 6.1% after SFR, P = 1.0). Conclusions: A postoperative standardized feeding regimen for patients with HPS decreased length of hospitalization and hospital costs without adverse effects. J Pediatr Surg 35:1063-1065. Copyright © 2000 by W.B. Saunders Company.

Section snippets

The pyloric SFR

The pyloric SFR is a feeding schedule developed by consensus of surgeons practicing in our institution and made available through the hospital ordering system (Table 1).

. The Pyloric SFR

10 mL 5% glucose solution orally
Increase by 10 mL every 2 hours to 30 mL
In increments of 3 hours:
 30 mL ½ strength formula orally
 45 mL ½ strength formula orally
 60 mL ½ strength formula orally
 60 mL full strength formula orally
 75 mL full strength formula orally
Then ad lib full strength formula orally
Formula-fed

Results

Patient demographics for control and SFR groups are presented in Table 2.

. Demographic Data

Empty CellControlSFRP Value
No. of patients studied94148
Age (d)34.5 ± 16.236.9 ± 17.9.28
Weight (kg)3.9 ± 0.64.0 ± 0.7.13
Male to female ratio3.1:17.7:1.01
Premature (%)12.814.9.71
Comorbid condition (%)17.017.61.0
Prophylactic antibiotics (%)28.720.9.22
Follow-up (%)*72.377.0.45
*Percentage of patients with at least 1 follow-up visit (usually occurred 1 to 2 weeks after discharge).
There were no significant differences in

Discussion

Several studies have investigated postoperative feeding regimens for HPS patients with respect to time of reintroduction of feeding and speed of advancement in an attempt to discover the safest and most cost-effective method. However, a review of results does not provide any single best technique. However, these studies do appear to support the contention that a more liberal feeding regimen probably does no harm. For example, Turnock and Rangecroft4 evaluated early (4 hour) versus late (18

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Address reprint requests to Kathryn D. Anderson, MD, FACS, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #72, Los Angeles, CA 90027.

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