实施胃造口术后的早期喂养途径可减少住院时间。

Implementing an early feeding pathway post gastrostomy insertion reduces inpatient stay.

机构信息

Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.

Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.

出版信息

J Pediatr Surg. 2020 May;55(5):861-865. doi: 10.1016/j.jpedsurg.2020.01.024. Epub 2020 Feb 13.

DOI:10.1016/j.jpedsurg.2020.01.024

PMID:32063364

Abstract

BACKGROUND

There is no consensus regarding optimal postoperative feeding strategy following gastrostomy insertion in children. The aim of this study was to determine whether implementing an early postoperative feeding pathway reduces length of stay (LOS) without increasing complications.

METHODS

A retrospective case note review of all children having a new gastrostomy inserted during a one-year period prior to (July 2016-July 2017) and following (July 2017-July 2018) pathway introduction was performed. Children unable to follow the pathway for coexisting medical or nutritional reasons were excluded. The pathway comprised feeding 50% of normal feed 2 hours postprocedure, followed by 100% of normal feed at 5 and 8 h. Previously, patients were fed postoperatively according to surgeon preference.

RESULTS

116 cases met inclusion criteria, 55 prior to and 61 after pathway implementation. Children following the early feeding pathway had a shorter postoperative LOS than the historical group (median 28 vs 33 h, p < 0.003), while immediate (<72 h) and early (<30 day) complication rates were similar (8.2 vs 7.3%, p = 1.00 and 12 vs 16%, p = 0.59, respectively).

CONCLUSIONS

Early postoperative feeding after gastrostomy insertion is safe and reduces LOS.

TYPE OF STUDY

Quality improvement.

LEVEL OF EVIDENCE

III.

摘要

背景

关于胃造口术后的最佳喂养策略，目前尚未达成共识。本研究旨在确定实施早期术后喂养途径是否可以在不增加并发症的情况下缩短住院时间（LOS）。

方法

对一年期间（2016 年 7 月至 2017 年 7 月）实施新胃造口术的所有儿童的病历进行回顾性分析，在此之前（2017 年 7 月至 2018 年 7 月）和之后（2017 年 7 月至 2018 年 7 月）。排除因共存的医学或营养原因而无法遵循该途径的儿童。该途径包括术后 2 小时内给予正常喂养量的 50%，然后在 5 和 8 小时时给予 100%的正常喂养量。在此之前，根据外科医生的偏好对患者进行术后喂养。

结果

符合纳入标准的有 116 例，其中 55 例在实施该途径之前，61 例在实施该途径之后。与历史组相比，遵循早期喂养途径的患儿术后 LOS 更短（中位数 28 比 33 小时，p<0.003），而即刻（<72 小时）和早期（<30 天）并发症发生率相似（8.2%比 7.3%，p=1.00 和 12%比 16%，p=0.59）。