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Potential benefits of fast-track concepts in paediatric colorectal surgery
Malcolm A West1, James F Horwood, Sally Staves
1Department of Colorectal Surgery, Royal Liverpool and Broadgreen University Teaching Hospitals, Liverpool, Merseyside, UK.
Insights
Enhanced Recovery After Surgery (ERAS) principles may not accelerate recovery in pediatric colorectal surgery patients. Children experienced longer hospital stays and slower recovery compared to adults in this study.
Area of Science:
- Pediatric Surgery
- Inflammatory Bowel Disease (IBD) Management
- Peri-operative Care Optimization
Background:
- Structured care pathways, including Enhanced Recovery After Surgery (ERAS), improve post-operative recovery in adults.
- The study investigated the applicability and benefits of ERAS principles for pediatric patients undergoing major colorectal resection for Inflammatory Bowel Disease (IBD).
Purpose of the Study:
- To determine if ERAS principles could benefit pediatric patients undergoing major colorectal resection for IBD.
- To compare post-operative recovery metrics between pediatric patients managed with standard care and adult patients managed with ERAS.
Main Methods:
- Children undergoing elective bowel resection for IBD at a pediatric unit were matched to adult cases from a tertiary center using an ERAS program.
- Matching criteria included disease type, gender, operative procedure, and ASA grade.
Main Results:
- Pediatric patients had a significantly longer total length of stay (9 vs. 6 days) compared to matched adult ERAS patients.
- Children were significantly slower to start solid diet (4 vs. 1 day) and mobilize post-operatively (4 vs. 1 day).
- No significant differences were observed in the time to bowel function restoration, 30-day readmissions, or in-hospital morbidity.
Conclusions:
- Application of ERAS in pediatric surgery has the potential to accelerate recovery and reduce post-operative length of stay.
- Implementing ERAS principles could improve the quality and efficiency of care for pediatric surgical patients.
- Further research is needed to optimize ERAS protocols for pediatric populations undergoing colorectal resections for IBD.
Background:
Structured care pathways optimising peri-operative care have been shown to significantly enhance post-operative recovery. We aim to determine if enhanced recovery after surgery (ERAS) principles could provide benefit for paediatric patients undergoing major colorectal resection for inflammatory bowel disease (IBD).
Methods:
Children undergoing elective bowel resection for IBD at a regional paediatric unit using standard methods of peri-operative care were matched to adult cases from an associated tertiary referral university hospital already using an ERAS program. Cases were matched for disease type, gender, operative procedure, and ASA grade.
Results:
Forty-four children undergoing fifty procedures were identified. Thirty-four were matched to adult cases. Total length of stay in the paediatric group was significantly longer than in the adult group (6 vs. 9 days; P=0.001). Paediatric patients were slower to start solid diet (1 vs. 4 days; P<0.0001) and were slower to mobilize post-operatively (1 vs. 4 days; P<0.0001). No difference was seen in time to restoration of bowel function (2 vs. 3 days; P=0.49). Thirty day readmissions and total in-hospital morbidity were not significantly different between the groups.
Conclusion:
Potentially, application of ERAS in paediatric surgery could accelerate recovery and reduce length of post-operative stay thereby improving quality and efficiency of care.
