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Early feeding after gastrostomy insertion: a retrospective analysis of a new protocol

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Abstract

Purpose

Enteral feeding following primary gastrostomy insertion in children has traditionally been governed by individual surgeon preference. Lam et al. (J Pediatr Surg 55(5):861–865, 10.1016/j.jpedsurg.2020.01.02, 2020) demonstrated the use of a streamlined post-operative feeding pathway which resulted in shortened length of stay. A modified version of this pathway was introduced in the Royal Hospital for Children, Glasgow in August 2020. Here we sought to evaluate the impact of this pathway on post-operative course.

Methods

This retrospective analysis evaluated pre-protocol (January 2019–March 2020) and post-protocol (August 2020–May 2021) datasets measuring the outcomes of post-operative time to first feed, time to full feeds, post-operative length of stay as well as dietetic team input. 30 days complications data were also included.

Results

77 patients met inclusion criteria—42 pre-protocol and 35 post-protocol. Children in the post-protocol group were found to have significantly reduced average time to first feed (median 2.5. vs 25.25 h, p < 0.0001) and full feeds (median 13 vs 55.5 h, p < 0.0001) as well as shorter length of stay (median 2 vs 3 days, p < 0.0001). Complications were comparable between the two groups. 19% of patients were seen in the pre-operative period by a dietician in the pre-protocol group vs 83% in the post-protocol group.

Conclusion

Early feeding after new gastrostomy insertion reduces time to first and full feeds as well as post-operative length of stay. No significant increase in complications was noted. These findings affirm the role of protocolised early feeding pathways in patients undergoing primary gastrostomy insertion.

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Acknowledgements

The authors would like to thank Karen Browning (Theatre Data Manager, Royal Hospital for Children, Glasgow) for assistance in obtaining the data sets and Robin Young (Statistician, University of Glasgow) for review of the statistical methods used.

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Authors and Affiliations

  1. Royal Hospital for Children, Glasgow, Scotland

    Aisha Tahira, Niamh Ryan, James Andrews & Rania Kronfli

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  1. Aisha Tahira
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  2. Niamh Ryan
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  3. James Andrews
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  4. Rania Kronfli
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Correspondence to Rania Kronfli.

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The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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Tahira, A., Ryan, N., Andrews, J. et al. Early feeding after gastrostomy insertion: a retrospective analysis of a new protocol. J Ped Endosc Surg 4, 1–7 (2022). https://doi.org/10.1007/s42804-022-00131-2

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  • DOI: https://doi.org/10.1007/s42804-022-00131-2

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