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

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. 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. 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. 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.