Investigating the use of preoperative nasogastric tubes and postoperative outcomes for infants with pyloric stenosis: a retrospective cohort study

PURPOSE: Literature is lacking regarding the role of nasogastric tubes in patients with pyloric stenosis. There is also no consensus among surgeons. Some believe that pyloric stenosis is a form of gastric outlet obstruction, and the stomach should be drained until the obstruction is relieved. Others claim that infants can handle their secretions, and draining the stomach may further exacerbate the alkalosis. This chart review examines the use of preoperative nasogastric tubes in a single pediatric institution and its effect on vomiting rates and length of stay. METHODS: After research ethics board approval, a retrospective review was performed on 109 patients admitted between January 1, 2007, and December 31, 2008, with pyloric stenosis who underwent pyloromyotomy. Data were collected on presence of a preoperative nasogastric tube, preoperative electrolyte levels, ultrasound characteristics, episodes of postoperative vomiting, and length of stay. RESULTS: One hundred six patients were used in the final analysis. A nasogastric tube was placed in 77 patients (73%). Patients with a preoperative nasogastric tube had significantly higher episodes of postoperative vomiting (P = .015; 95% confidence interval [CI] 0.29-2.63) and length of stay (P = .017; 95% CI, 2.49-25.01). Bicarbonate levels were also significantly higher in patients with a nasogastric tube. There was no difference in the duration of symptoms, ultrasound characteristics, or type of operation between the 2 cohorts. CONCLUSION: The data strongly suggest that preoperative nasogastric tube placement adversely affects postoperative vomiting and consequently increases length of stay. The lack of consensus about the use of preoperative nasogastric tubes coupled with these findings indicates the need to evaluate this practice with a prospective randomized controlled trial.