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ERAS protocol for pediatric laparoscopic cholecystectomy promotes safe and early discharge
Andrew Yeh1, Gabriella Butler2, Stephen Strotmeyer2
1Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Insights
Implementing an Enhanced Recovery After Surgery (ERAS) protocol for pediatric laparoscopic cholecystectomy (LC) significantly increased same-day discharge (SDD) rates. This approach maintained excellent patient outcomes without increasing emergency department visits.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- ERAS Protocols
Background:
- Historically, pediatric patients undergoing elective laparoscopic cholecystectomy (LC) at our institution were admitted for an overnight hospital stay (OHS).
- This practice presented opportunities for optimizing patient management and discharge pathways.
Purpose of the Study:
- To implement an Enhanced Recovery After Surgery (ERAS) protocol for elective LC in pediatric patients.
- The primary goal was to promote same-day discharge (SDD) while ensuring excellent clinical outcomes.
Main Methods:
- An ERAS protocol was implemented, covering pre-, peri-, and postoperative care for elective LC.
- A retrospective review compared prospectively collected data from patients before (BI) and after (AI) protocol implementation.
Main Results:
- The study included 250 patients (105 BI, 145 AI).
- The AI group demonstrated a significantly higher SDD rate (77.2% vs. 1.9%, p<0.01) and reduced opioid use (0.36 vs. 0.46 mg/kg morphine equivalents, p<0.001).
- No significant differences were observed in 30-day total or surgery-related emergency department visits between groups.
Conclusions:
- The ERAS protocol significantly enhanced SDD rates for pediatric elective LC.
- This improvement was achieved without a concurrent rise in emergency department visits or readmissions.
Purpose:
Elective laparoscopic cholecystectomy (LC) pediatric patients in our institution have historically been admitted for an overnight hospital stay (OHS). The purpose of this study was to implement an ERAS protocol for elective LC in pediatric patients to promote same-day discharge (SDD) while maintaining excellent outcomes.
Methods:
An ERAS protocol for elective LC was implemented encompassing pre-, peri-, and postoperative management. A retrospective review of prospectively collected data from patients before (BI) and after implementation (AI) of the protocol was performed.
Results:
A total of 250 patients (BI 105, AI 145) were included in the study. The AI group had significantly higher rate of SDD compared to BI (77.2% vs. 1.9%, p < <0.01) and significantly decreased opioid use (morphine equivalents mg/kg AI 0.36 vs. BI 0.46, p < <0.001). There were also no significant differences in the rate of total 30-day emergency department visits (BI 11.4% vs. AI 9.7%, p = 0.52) or surgery-related 30-day emergency department visits (BI 7.6% vs. AI 8.3%, p = 0.53). Factors that predisposed patients to an OHS after LC included higher ASA, later surgery start times, and longer operative times.
Conclusions:
The ERAS protocol significantly increased the rate of SDD after elective LC in pediatric patients without an associated increase in emergency department visits or readmissions.
Level Of Evidence:
III.
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