title: Ad libitum feeding: safely improving the cost-effectiveness of pyloromyotomy.
abstract: OBJECTIVE
  Patients undergoing pyloromyotomy traditionally have been placed on complex postoperative feeding regimens. The authors evaluated the substitution of an ad libitum feeding regimen to determine if it could decrease length of hospital stay and cost without increasing the morbidity rate.
  
  
  METHODS
  Fifty-six consecutive patients undergoing open pyloromyotomy were evaluated. The initial 31 patients were treated with a traditional protocol, whereas the next 25 patients received ad libitum feeding. Time to first full-strength feeding, amount and time of any emesis, and time to discharge were recorded. Hospital costs and number of readmissions were assessed.
  
  
  RESULTS
  Patients in the ad libitum group had a statistically significant shorter time to discharge (25.1 hours versus 38.8 hours), which translated into a savings of $1,290 per patient. Whereas more patients in the ad libitum group experienced postoperative emesis (32% v 26%), this was not statistically significant. There was no other morbidity and there were no readmissions in either group.
  
  
  CONCLUSIONS
  Postoperative ad libitum feedings resulted in significant decreases in hospital stay and associated costs without increasing morbidity. Ad libitum feeding is safe, simple, and cost effective, and may offer an avenue for short-stay pyloromyotomy in selected patients.
authors.affiliation: Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027, USA.
authors.forename: Devin
authors.initials: D
authors.lastname: Puapong
authors.forename: David
authors.initials: D
authors.lastname: Kahng
authors.forename: Albert
authors.initials: A
authors.lastname: Ko
authors.forename: Harry
authors.initials: H
authors.lastname: Applebaum
mesh_terms: D003362:Cost-Benefit Analysis; D004869:Equipment Safety; D005248:Feeding Methods / Q000191:economics*; D006801:Humans; D006984:Hypertrophy; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics; D011182:Postoperative Care / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011707:Pyloric Stenosis / Q000534:rehabilitation / Q000601:surgery*; D011708:Pylorus / Q000473:pathology / Q000601:surgery*