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Enhancing recovery after minimally invasive repair of pectus excavatum

Cristen N Litz1, Sandra M Farach2, Allison M Fernandez3

  • 1Division of Pediatric Surgery, Outpatient Care Center, Johns Hopkins All Children's Hospital, 601 5th Street South, Dept 70-6600, 3rd Floor, St. Petersburg, FL, 33701, USA. clitz@health.usf.edu.

Pediatric Surgery International
|August 31, 2017
PubMed
Abstract

Insights

Implementing an enhanced recovery pathway for minimally invasive repair of pectus excavatum (MIRPE) reduced hospital resource use and improved patient outcomes. This standardized approach is effective for pediatric patients undergoing MIRPE.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Surgical Outcomes

Background:

  • Variations exist in perioperative management for minimally invasive repair of pectus excavatum (MIRPE).
  • Standardized practice plans and enhanced recovery pathways can optimize patient care.
  • Resource utilization and patient outcomes in MIRPE require further analysis.

Purpose of the Study:

  • To analyze changes in resource utilization following the implementation of a standardized practice plan for MIRPE.
  • To describe an enhanced recovery pathway for pediatric patients undergoing MIRPE.
  • To evaluate the impact of a pain management protocol on outcomes after MIRPE.

Main Methods:

  • Retrospective review of 71 patients undergoing MIRPE from 2012-2015 to assess resource utilization trends after a standardized plan (implemented 2013).
  • Retrospective review of 64 patients undergoing MIRPE before (2010-2012) and after (2014-2015) implementation of a pain management protocol.
  • Analysis included intensive care unit length of stay, laboratory and radiologic studies, postoperative pain scores, and urinary retention rates.

Main Results:

  • Following the standardized plan, a decrease in intensive care unit length of stay and fewer laboratory/radiologic studies were observed.
  • After implementing the pain protocol, significant reductions were noted in postoperative morphine equivalents (3.3 to 1.2 mg/kg) and length of stay (4 to 2.8 days).
  • Urinary retention rates requiring catheterization also decreased (33% to 14%), though not statistically significant (p=0.07).

Conclusions:

  • Implementation of an enhanced recovery pathway for MIRPE is feasible and effective.
  • This pathway significantly reduces resource utilization in pediatric patients undergoing MIRPE.
  • Enhanced recovery pathways improve outcomes for pediatric patients undergoing minimally invasive repair of pectus excavatum.
Keywords:
Enhanced recoveryMIRPENussPain managementPectus excavatumQuality improvement

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