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SAFE AND MORE RAPID DISCHARGE WITH AD LIBITUM FEEDING AFTER PYLOROMYOTOMY
*Frances Okolo, *Marissa Narr, *Marcus Malek
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA

OBJECTIVE(S): Feeding protocols after pyloromyotomy have traditionally varied amongst surgeons and institutions. At our institution, feeds were withheld for 6 hours postoperatively with subsequent slow advancement of feeds beginning with 15mL pedialyte, until goal feeds are reached. Recent evidence suggests that ad lib feedings after a 4-hour fasting period may decrease length of stay and hospital costs without adverse events. We aim to develop a multidisciplinary protocol for ad lib feedings at our institution, and compare outcomes with our historic protocol.
METHODS: Close collaboration between physicians, nursing, and information technology staff allowed for the creation and implementation of an ad lib feeding protocol which was initiated on 5/1/2017. A comprehensive retrospective chart review identified patients with pyloric stenosis who underwent pyloromyotomy from 1/1/2014 to 3/31/2018. Patients from before (BP) and after the protocol (AP) initiation date were compared for length of stay, time from surgery completion to goal feedings and discharge, postoperative emesis, and return to emergency department/readmission rate.
RESULTS: A total of three hundred and thirty-six (N = 336) eligible patients were included in the study (n = 273, BP; n = 63, AP). There was a significant difference in time from surgery completion to tolerance of 2 consecutive goal feedings (p < 0.001) and time from surgery completion to discharge (p = 0.008) between the two protocol groups. Postoperative emesis was significantly increased in the ad lib protocol group (p = 0.011). No significant differences were noted in the return to the emergency department/readmission for postoperative complications (p = 0.26).
CONCLUSIONS: Despite an increase in postoperative emesis, ad lib feeding after pyloromyotomy is a safe approach that allows patients to reach goal feedings more rapidly, and decreases the time from surgery to discharge, without an increase in postoperative ED visits or readmissions.

Table 1. Comparison of patients in institution and ad lib protocol
Institution Protocol N=273Ad Lib Protocol N=63p-value
Time from surgery completion to goal feedings (hours)18.73 13.610.67 15.41<0.001
Time from surgery completion to hospital discharge (hours)23.13 17.7521.63 18.420.008
Hospital length of stay (days)1.83 0.961.90 1.020.25
Post-operative emesis84 (30.8%)30 (47.6%)0.011
Return to the emergency department/Readmission6 (2.2%)3 (4.8%)0.26


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