Healthcare Utilization Following Implementation of a Standardized Gastrostomy Tube Care Pathway: A Retrospective Cohort Study.

BACKGROUND: Perioperative management of pediatric gastrostomy tube placement varies widely across institutions, particularly with respect to time to first feed, length of stay (LOS), and resource utilization. We evaluated the impact of implementing a standardized perioperative care pathway on postoperative recovery and hospital resource utilization. METHODS: We conducted a single-institution retrospective cohort study of children undergoing planned gastrostomy tube placement from March 2019 to June 2025. Patients were categorized into pre-implementation (3/2019 to 11/2022), dissemination (12/2022 to 4/2024), and post-implementation (5/2024 to 6/2025) periods based on pathway rollout. Time to first feed, postoperative LOS, and standardized hospital cost derived from PHIS data were compared across implementation periods using Kruskal-Wallis tests and multivariable generalized linear models adjusted for age, sex, race/ethnicity, and medical complexity. RESULTS: Among 343 patients, 179 underwent surgery pre-implementation, 96 during dissemination, and 68 post-implementation. From pre- to post-implementation, median time to first feed decreased from 6.9 to 3.6 hours (p < 0.001), LOS decreased from 29.7 to 24.8 hours (p < 0.001), same-day discharge increased from 2.8% to 29.4% (p < 0.001), and median standardized costs decreased from $9,554 to $7,517 (p < 0.001). In adjusted analyses, standardized hospital costs were 28% lower post-implementation compared with pre-implementation (adjusted cost ratio 0.72, 95% CI 0.66 to 0.79). CONCLUSIONS: Implementation of a standardized gastrostomy tube care pathway was associated with shorter time to first feed, shorter postoperative LOS, and lower standardized hospital costs, supporting the role of structured perioperative pathways in improving efficiency and resource utilization in pediatric surgical care.