Minimizing hospital length of stay in children undergoing ureteroneocystostomy

Abstract

Objectives: Shortening hospital stay yet not compromising quality of care can result in significant cost savings for children undergoing surgical correction of vesicoureteral reflux.

Methods: We reviewed the medical records of pediatric patients who underwent ureteroneocystostomy between July 1995 and July 1997. A total of 43 patients, aged 0.2 to 18 years (mean 5.2) who all received identical postoperative care, except for their pain management and the time of bladder catheter removal, were included in the study. Twenty-three were treated with intravenous ketorolac tromethamine (Toradol); the remaining 20 received narcotics in the immediate postoperative period. The bladder catheter was removed in less than 24 hours in 22 children, and greater than 24 hours in 21.

Results: Patients who received ketorolac tromethamine for postoperative analgesia had on average shorter hospital length of stays than those treated with narcotics (1.4 versus 2.5 days, respectively; P < 0.001). The average stay for children whose bladder catheter was removed within 24 hours postoperatively was significantly shorter than those whose catheter was removed after a 24-hour period (1.4 versus 2.4 days, respectively; P < 0.001). There were no reimplantation failures. One child presented 2 days postoperatively with anemia, which did not require transfusion.

Conclusions: Our review demonstrates that ketorolac tromethamine can be used safely and effectively in children for immediate postoperative analgesia, and that its proper use combined with early catheter removal can reduce the length of hospital stay for pediatric patients undergoing ureteroneocystostomy.