The effect of standardized discharge instructions after gastrostomy tube placement on postoperative hospital utilization.

Abstract

BACKGROUND/PURPOSE\nGastrostomy tube (GT) placement is a common pediatric procedure with high postoperative resource utilization. We aimed to determine if standardized discharge instructions (SDI) reduced healthcare utilization rates.\n\n\nMETHODS\nWe performed a retrospective cohort study comparing postoperative hospital utilization of patients who underwent initial GT placement pre- and post-SDI protocol implementation from 2014-2019. Statistical analyses included Chi-square tests, multivariable adjusted logistic regression, adjusted Cox proportion hazard regression, and adjusted Poisson regression models when appropriate.\n\n\nRESULTS\n197 patients were included, 102 (51.8%) before and 95 (48.2%) after protocol implementation. On primary analysis, SDI patients did not have significantly different total postoperative hospital utilization events at 30-days (48.0% vs. 38.9%, p\xa0=\xa00.25). On secondary analysis, SDI patients had lower rates of ED (8.4% vs. 19.6%, p\xa0=\xa00.026) and office visits (11.6% vs. 25.5%, p\xa0=\xa00.017) at 30-days. Non-SDIs patients had greater odds of ED visits (OR2.7, 95%CI 1.3-5.9, p\xa0=\xa00.01), office visits (OR3.7, 95%CI 1.7-8.1, p\xa0=\xa00.001) and phone calls (OR2.6, 95%CI 1.2-5.7, p\xa0=\xa00.016) at 1-year. The adjusted hazard ratio was 2.0 (95%CI 1.4-3.0, p\xa0<\xa00.001). Incident rate ratio were 1.8 (95%CI 1.2-2.5, p\xa0=\xa00.002) at 30-days and 1.9 (95%CI 1.5-2.4, p\xa0<\xa00.001) at 1-year post-discharge.\n\n\nCONCLUSIONS\nSDIs post-GT placement may reduce multiple aspects of postoperative hospital utilization.