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Implementation of an enhanced recovery protocol in pediatric colorectal surgery
Heather L Short1, Kurt F Heiss1, Katelyn Burch1
1Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Insights
Implementing enhanced recovery protocols (ERPs) in pediatric colorectal surgery is feasible and safe, leading to shorter hospital stays and reduced narcotic use. Further optimization may improve outcomes even more.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Enhanced Recovery Protocols
Background:
- Enhanced Recovery Protocols (ERPs) are established to improve surgical outcomes in adults.
- Pediatric surgical populations have unique needs that may benefit from tailored ERPs.
Purpose of the Study:
- To compare outcomes in children undergoing elective colorectal surgery before and after implementing a pediatric-specific ERP.
- To assess the feasibility, safety, and impact of ERPs on pediatric colorectal surgery patients.
Main Methods:
- A pediatric colorectal enhanced recovery protocol (ERP) was developed and implemented at a single institution.
- A retrospective review compared 43 patients (pre-ERP, 2012-2014) with 36 patients (post-ERP, 2015-2016).
- Key outcomes included ERP interventions, length of stay, complications, and readmissions.
Main Results:
- The median number of ERP interventions per patient increased from 5 to 11.
- Median length of stay significantly decreased from 5 to 3 days (p=0.01).
- Significant reductions were observed in time to regular diet, narcotic dosage, and intraoperative fluid volumes (p<0.001).
- Complication rates (21% vs. 17%) and 30-day readmissions (23% vs. 11%) were not significantly different.
Conclusions:
- A pediatric-specific ERP for colorectal surgery is feasible and safe.
- ERP implementation in this pediatric cohort led to a reduced length of stay and decreased opioid and fluid requirements.
- Further research can explore optimizing ERP compliance for enhanced patient care.
Purpose:
Enhanced recovery protocols (ERPs) have been shown to improve outcomes in adult surgical populations. Our purpose was to compare outcomes before and after implementation of an ERP in children undergoing elective colorectal surgery.
Methods:
A pediatric-specific colorectal ERP was developed and implemented at a single center starting in January 2015. A retrospective review was performed including 43 patients in the pre-ERP period (2012-2014) and 36 patients in the post-ERP period (2015-2016). Outcomes of interest included number of ERP interventions received, length of stay (LOS), complications, and readmissions.
Results:
The median number of ERP interventions received per patient increased from 5 to 11 from 2012 to 2016. The median LOS decreased from 5days to 3days in the post-ERP period (p=0.01). We observed a simultaneous decrease in median time to regular diet, mean dose of narcotics, and mean volume of intraoperative fluids (p<0.001). The complication rate (21% vs. 17%, p=0.85) and 30-day readmission rate (23% vs. 11%, p=0.63) were not significantly different in the pre- and post-ERP periods.
Conclusions:
Implementation of a pediatric-specific ERP in children undergoing colorectal surgery is feasible, safe and may lead to improved outcomes. Further experience may highlight other opportunities for increased compliance and improved care.
Level Of Evidence:
Treatment Study. Level III.
