title: Is one-day hospitalization after open pyeloplasty possible and safe?
abstract: OBJECTIVE
  A critical pathway was developed to determine whether open pyeloplasty could be performed in preadolescent and adolescent children with ureteropelvic junction (UPJ) obstruction with patients safely discharged after a 1-day hospitalization.
  
  
  METHODS
  Twenty-six consecutive children who underwent open dismembered pyeloplasty for the treatment of UPJ obstruction and followed a critical pathway for preoperative education, operative management, and postoperative care were evaluated. The patients received a caudal anesthetic for preventive analgesia unless not technically possible and postoperative ketorolac (Toradol) unless contraindicated. A child was required to fulfill five strict criteria to be discharged from the hospital.
  
  
  RESULTS
  The 26 patients with UPJ obstruction consisted of 18 boys and 8 girls (age range 2.4 months to 16.7 years). Of the 26 patients, 24 (92%) were discharged on the first postoperative day, with a mean length of hospitalization of 1.1 days (range 1 to 3). All patients younger than 6 years of age (19 patients) were discharged on the first postoperative day. Of the 25 patients who received a caudal block, 24 (96%) were discharged on the first postoperative day. All patients tolerated the procedure well without major complications.
  
  
  CONCLUSIONS
  This is the first study, to our knowledge, to describe a detailed critical pathway for open pyeloplasty to treat UPJ obstruction. This enabled all children younger than 6 years of age and more than 90% of all patients to be discharged uniformly on the first postoperative day.
authors.affiliation: Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: Yvonne K
authors.initials: YK
authors.lastname: Piedrahita
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Palmer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D013997:Time Factors; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods