Minimizing variance in pediatric gastrostomy

Does standardized perioperative feeding plan decrease cost and improve outcomes?

Rachel Sunstrom, Nicholas Hamilton, Elizabeth Fialkowski, Katrine Lofberg, Julie McKee, Thomas Sims, Sanjay Krishnaswami, Kenneth Azarow

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Nov 5 2015

Fingerprint

Gastrostomy
Hospital Costs
Length of Stay
Pediatrics
Guideline Adherence
Costs and Cost Analysis
Control Groups
Patient Compliance
Hospitalization
Anti-Bacterial Agents
Surgeons

Keywords

  • Gastrostomy
  • Minimizing variance
  • Pediatric surgery
  • Standardizing care

ASJC Scopus subject areas

  • Surgery

Cite this

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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.",
keywords = "Gastrostomy, Minimizing variance, Pediatric surgery, Standardizing care",
author = "Rachel Sunstrom and Nicholas Hamilton and Elizabeth Fialkowski and Katrine Lofberg and Julie McKee and Thomas Sims and Sanjay Krishnaswami and Kenneth Azarow",
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T2 - Does standardized perioperative feeding plan decrease cost and improve outcomes?

AU - Sunstrom, Rachel

AU - Hamilton, Nicholas

AU - Fialkowski, Elizabeth

AU - Lofberg, Katrine

AU - McKee, Julie

AU - Sims, Thomas

AU - Krishnaswami, Sanjay

AU - Azarow, Kenneth

PY - 2015/11/5

Y1 - 2015/11/5

N2 - 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.

AB - 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.

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