Safety and Feasibility of Paediatric Day Case Laparoscopic Upper Gastrointestinal Surgery: Significance of Nurse-led Discharge.

BACKGROUND

Day case (DC) surgery is defined as a surgical procedure that allows patients to go home the same day as their operation. Laparoscopic upper gastrointestinal surgery (LUGIS) has become the standard treatment for symptomatic gallstone disease, refractory gastroesophageal reflux disease, and achalasia cardia. This study aims to assess the feasibility and safety of performing paediatric DCLUGI surgery with discharge implemented by a nurse-led team according to preset criteria.

METHODS

Electronic records were evaluated for all neurologically normal patients who underwent LUGIS from July 2015 to July 2023 following a dedicated clinical care pathway. Data collection included demographics, length of stay (DC, ≤23-h, ≥24-h), surgeon level, complications and postoperative pain management. Nurse-led discharge (NLD) was implemented for all patients according to preset criteria.

RESULTS

Seventy-four patients underwent LUGIS (31 cholecystectomies, 31 fundoplications and 12 Heller myotomies) with a DC rate of 12 %. Twenty-five (34 %) patients were ≤23-h stay. All early discharge (DC and ≤23-h) patients (46 %) were safely managed according to the NLD criteria without postoperative medical review. There were no thirty-day readmissions.

CONCLUSIONS

DC or ≤23-h LUGIS can be performed safely in high-volume paediatric specialist centres with good outcomes. Implementing protocols that provide nursing staff with the necessary guidance to ensure timely discharge of children and young people is fundamental to achieving high levels of satisfaction and the delivery of an efficient service.