Pediatric Urologist performs same-day procedure for kidney obstruction
Avoiding an overnight stay in a hospital is always appreciated by parents of little ones. So when Easton Swick of Painesville needed a pyeloplasty for an ureteropelvic junction obstruction during the pandemic, Pediatric Urologist Jessica Hannick, MD, MSc at University Hospitals Rainbow Babies & Children’s Hospital was able to make several positive adjustments to ensure the 8-month-old boy went home the same day.
“We were really hoping not to have to stay in the hospital overnight,” says Jensine Swick, who also has a 3-year-old at home. “COVID only adds to a parent’s stress.”
A prenatal ultrasound revealed her baby’s enlarged kidneys before Easton’s November birth, so Jensine and her husband, Brian, knew he might need surgery one day. Easton had his first procedure, to remove part of his diseased ureter and insert a stent, when he was just 1 month old. Since he was younger than 6 months old and potentially higher risk for breathing issues after anesthesia, Easton spent a night in the hospital after his first surgery. With the second surgery at 8 months old, Dr. Hannick was able to discharge her young patient before nightfall.
This ERAS (enhanced recovery after surgery) approach included a regional anesthetic pain block, immediate removal of the baby’s catheter following surgery, and an external post-operative drain so he wouldn’t need additional anesthesia to remove the drain in the future. Many institutions still keep their patients overnight, but Dr. Hannick’s practices actually ensure safe discharge of the patient on the same day as surgery in coordination with the family’s comfort level.
“I instituted several principles from an approach to surgical care called ERAS, or enhanced recovery after surgery, which ultimately helps us to achieve shorter lengths of stay,” Dr. Hannick says. “In Easton’s case, he received a particular anesthetic regional pain block, an ultrasound-guided quadratus lumborum block, that optimized his post-operative pain control. His Foley catheter was immediately removed at the end of the case. And his post-operative drain (ureteral stent) was externalized, so that he would not have to undergo an additional anesthetic to have the drain removed in the future.”
Jensine and Brian were pleased that they could take their baby home after a few hours on the post-operative observation floor. They returned to UH Rainbow 10 days later for Easton’s stent removal.
“It was stressful enough to have a 3-year-old at the time, so to have to be overnight at the hospital with an infant – especially with COVID restrictions – only compounded our concerns. We appreciated being able to bring our baby home to his own environment, which allowed us all to rest.”
“This was performed as a same-day surgery, which isn’t necessarily typical,” Dr. Woo says. “It’s a huge benefit to families, especially during these COVID times.”