Effect of implementing an enhanced recovery protocol for pediatric colorectal surgery on complication rate, length of stay, and opioid use in children.

Autor: George JA; Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology, Johns Hopkins University, The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Suite 6321, Baltimore, MD 21287, United States. Electronic address: jgeorg24@jhmi.edu., Salazar AJG; Department of General Surgery, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, United States., Irfan A; Department of Surgery, University of Alabama at Birmingham, 202 Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35233, United States., Prichett L; Biostatistics, Epidemiology and Data Management (BEAD) Core, Department of Pediatrics, Johns Hopkins University School of Medicine, Mason F. Lord Bldg, Center Tower, Suite 4200, 5200 Eastern Ave., Baltimore, MD 21224, United States., Nasr IW; Department of General Pediatric Surgery, Johns Hopkins University, The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Suite 7323, Baltimore, MD 21287, United States., Garcia AV; Department of General Pediatric Surgery, Johns Hopkins University, The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Suite 7323, Baltimore, MD 21287, United States., Boss EF; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Baltimore, MD 21287, United States., Jelin EB; Department of General Pediatric Surgery, Johns Hopkins University, The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Suite 7323, Baltimore, MD 21287, United States.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2022 Jul; Vol. 57 (7), pp. 1349-1353. Date of Electronic Publication: 2022 Jan 15.
DOI: 10.1016/j.jpedsurg.2022.01.004
Abstrakt: Introduction In the past two decades, Enhanced Recovery After Surgery (ERAS) pathways for adults have improved efficiency of care and decreased length of stay (LOS) without increasing postoperative complications. The effects of enhanced recovery pathways for children are less well known. In this retrospective cohort study, we evaluated the effects of an enhanced recovery protocol (ERP) implementation in children undergoing colorectal surgery. Methods We introduced a colorectal ERP in 2017. Children and young adults (ages 2-22 years) were divided into pre-intervention (2014-2016) and post-intervention groups (2017-2019) for analysis. We abstracted data, including demographics, primary surgery, LOS, postoperative pain scores, and postoperative complications. Results A total of 432 patients were included. Of those,148 (34%) were pre-ERP implementation and 284 (66%) were post-ERP implementation. Post-ERP patients experienced significantly shorter LOS (5.7 vs. 8.3 days, p<0.01); required less intraoperative local anesthetic (9.5% vs. 38.5%, p<0.01) because 55% of patients received an epidural and 18% received an abdominal plane block; and used less postoperative opioid (62.5% vs. 98.7%, p<0.01) than did pre-ERAS patients. After protocol implementation, average pain scores were lower on postoperative day 1 (3.6 vs. 4.5, p<0.05) and across the hospitalization (3.0 vs. 4.0, p<0.01). Conclusion Enhanced recovery pathways decrease LOS, opioid use, and postoperative pain scores for children undergoing colorectal surgery and should be considered for this patient population.
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
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