title: Pyloric stenosis--postoperative care on a nonsurgical ward.
abstract: BACKGROUND
  Recent progress has been made in the care of infants with hypertrophic pyloric stenosis (HPS), including earlier operative intervention and shorter hospital length of stay (LOS), which is attributable to expedited postoperative feeding protocols developed and implemented by surgeons. We hypothesized that patients with HPS admitted to a unit that is co-managed by nonsurgeon providers postoperatively have a longer LOS than those on the surgical ward.
  
  
  METHODS
  We reviewed the medical records of infants who underwent pyloromyotomy for HPS at a single institution from April, 2009-July, 2013.
  
  
  RESULTS
  A total of 259 patients underwent pyloromyotomy (35 female; 13.5%), 205 (79%) were admitted to the surgical ward; 46 had a planned neonatal intensive care unit (NICU) admission (18%) and were co-managed with the neonatology team. Eight (3%) had an unplanned NICU admission and were excluded from the analysis. The groups did not differ in terms of sex, age, serum electrolytes at presentation, or time between surgeon evaluation and operative intervention. Surgical ward patients had longer preoperative symptom duration. Operative time was longer in the NICU patients. Comparing the two groups, there was no difference in postoperative apnea, hypoxic, or bradycardic episodes. NICU patients achieved ad libitum feeds later than floor patients (2.0 versus 1.4 d; P = 0001) and had a longer postoperative LOS (2.2 versus 1.6 d; P = 0.0012).
  
  
  CONCLUSIONS
  Patients with HPS admitted to the NICU postoperatively had a longer time to full feeds and hospital LOS. The reduction in LOS between hospital wards may be improved with implementation of a hospital-wide postoperative protocol for patients with HPS.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: shannon.acker@ucdenver.edu.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Kulungowski
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Maggie
authors.initials: M
authors.lastname: Hodges
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Crombleholme
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Stig
authors.initials: S
authors.lastname: Somme
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
mesh_terms: D002985:Clinical Protocols / Q000592:standards; D004750:Enteral Nutrition / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011182:Postoperative Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D013503:Surgery Department, Hospital / Q000592:standards; D016896:Treatment Outcome
keywords: Hypertrophic pyloric stenosis; Nonsurgical postoperative care; Postoperative care unit; Prolonged length of stay