title: Minimizing variance in pediatric gastrostomy: does standardized perioperative feeding plan decrease cost and improve outcomes?
abstract: BACKGROUND
  A protocol for laparoscopic gastrostomy placement was implemented which specified perioperative antibiotics, feeding regimens, and discharge criteria. Our hypothesis was that hospital cost could be decreased, whereas at the same time improving or maintaining patient outcomes.
  
  
  METHODS
  Data were collected on consecutive patients beginning 6 months after implementation of our protocol. We recorded surgeon compliance, patient outcomes (as defined by 30-day NSQIP complication rates), and cost of initial hospitalization, which was then compare to a 6-month historical control period.
  
  
  RESULTS
  Our control group n = 26 and protocol group n = 39. Length of stay was shorter in the protocol group (P ≤ .05 by nonparametric analysis). The complication rate was similar in both groups (23% control vs 15% protocol, P = .43). Initial hospital costs were not different. Surgeon compliance to protocol was 82%.
  
  
  CONCLUSIONS
  A standard protocol is achievable for gastrostomy tube management. After implementation of our protocol, we were able to show a significant decrease in length of stay, whereas maintaining quality.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Sunstrom
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hamilton
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fialkowski
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Katrine
authors.initials: K
authors.lastname: Lofberg
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: McKee
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sims
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Krishnaswami
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA. Electronic address: azarow@ohsu.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Azarow
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000191:economics; D010372:Pediatrics; D019990:Perioperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Gastrostomy; Minimizing variance; Pediatric surgery; Standardizing care