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Enhanced recovery after surgery (ERAS) protocols in neonates should focus on the respiratory tract
Yuji Wakimoto1, Sathyaprasad Burjonrappa2
1NYU-Winthrop University Hospital, 259 1st St, Mineola, NY, 11501, USA.
Insights
Early extubation after neonatal surgery is linked to fewer adverse respiratory events. Implementing enhanced recovery after surgery (ERAS) protocols in neonatal intensive care units (NICUs) may improve patient outcomes.
Area of Science:
- Neonatal surgery
- Pediatric critical care
- Surgical outcomes
Background:
- Enhanced recovery after surgery (ERAS) protocols demonstrate benefits in adult surgery.
- ERAS protocols are underutilized in neonatal settings.
- Prolonged intubation post-neonatal surgery is a barrier to ERAS implementation.
Purpose of the Study:
- To investigate the association between prolonged post-operative intubation and adverse events in neonates.
- To evaluate the impact of extubation timing on respiratory outcomes in surgical neonates.
Main Methods:
- Retrospective cohort study of neonates undergoing surgery and intubation (2012-2016).
- Categorization of post-operative extubation into immediate (<24 hours) and delayed (>24 hours).
- Statistical analysis using Fisher exact test and Student's t test.
Main Results:
- 58 surgical procedures met inclusion criteria; 28 had immediate extubation, 30 had delayed extubation.
- The incidence of adverse respiratory events was significantly higher in the delayed extubation group (P=0.03).
Conclusions:
- Early extubation following neonatal surgery is recommended to reduce adverse respiratory events.
- Consideration should be given to adapting ERAS protocols for neonatal intensive care units (NICUs).
Background/Purpose:
Enhanced recovery after surgery (ERAS) protocols have shown significant benefits in terms of patient outcomes and institutional cost savings in colorectal and bariatric surgery. This has not, however, been tried in the neonatal setting. One of the major barriers to developing ERAS protocols in the neonatal intensive care unit (NICU) is the often-prolonged intubation of neonates after surgery. To this end, we evaluated our institutional data to determine if prolonged intubation post-operatively is associated with adverse events.
Methods:
This is a retrospective cohort study of neonates who were intubated for a surgical procedure from January 2012 to December 2016. Documented data included pre-operative intubation status, timing of post-operative extubation: immediate (< 24 h) or delayed (> 24 h), and adverse respiratory events. The Fisher exact test and Student's t test were used to study differences amongst categorical and continuous variables, respectively.
Results:
58 surgical procedures were identified, where the patient was intubated specifically for the surgical intervention, of which 28 were extubated immediately and 30 were extubated in a delayed fashion. The overall incidence of adverse respiratory events was increased in the delayed extubation group (P = 0.03).
Conclusions:
Healthcare providers should encourage early extubation after neonatal surgery. Consideration should be given to implementing ERAS protocols in NICUs.
Level Of Evidence:
Prognosis study-level II.
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