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Enhanced Recovery After Surgery in Pediatric and Adolescent Gynecology: A Pilot Study
Abigail E Smith1, Kurt Heiss2, Krista J Childress3
1Children's Healthcare of Atlanta, Atlanta, GA.
Insights
Enhanced Recovery After Surgery (ERAS) protocols are safe and effective for pediatric gynecologic surgery, reducing narcotic use and improving patient satisfaction without increasing complications. This study demonstrates feasibility in this patient population.
Area of Science:
- Pediatric Surgery
- Gynecologic Oncology
- Perioperative Medicine
Background:
- Enhanced Recovery After Surgery (ERAS) protocols have demonstrated success in various surgical fields, reducing complications, length of stay, and narcotic use.
- However, the application of ERAS in pediatric and adolescent gynecology (PAG) remains understudied.
- This study aims to evaluate the initial outcomes of ERAS implementation in PAG patients undergoing intra-abdominal gynecologic surgery.
Purpose of the Study:
- To assess the efficacy of an ERAS protocol in pediatric and adolescent gynecology patients.
- To evaluate patient satisfaction with the ERAS protocol.
- To determine the impact of ERAS on narcotic use and postoperative outcomes in this population.
Main Methods:
- A quality improvement initiative implemented a comprehensive ERAS protocol (preoperative, intraoperative, postoperative) for all intra-abdominal gynecologic procedures performed by the PAG service.
- A retrospective study analyzed data from 40 patients (<25 years) who underwent laparoscopic (LSC) or open abdominal (XLAP) gynecologic surgery.
- Outcomes measured included patient satisfaction, pain management, narcotic use, length of stay (LOS), return to system (RTS), and postoperative complications.
Main Results:
- All 40 participants met inclusion criteria, with 34 undergoing LSC and 6 XLAP procedures.
- 95% of LSC patients and all XLAP patients were discharged on postoperative day 0 or 1.
- 95% of patients were discharged on non-narcotic pain medication, with no readmissions or complications reported. All patients reported satisfaction with pain control.
Conclusions:
- Implementing a pediatric-specific ERAS protocol for gynecologic surgery is feasible and safe.
- ERAS protocols in PAG lead to reduced narcotic utilization.
- The study indicates no increase in complications or decrease in patient satisfaction with ERAS implementation in this cohort.
Study Objective:
Enhanced recovery after surgery (ERAS) protocols have been successfully implemented in adult gynecology as well as adult and pediatric colorectal and urologic surgery with reduction in narcotic use, complications, return to the system (RTS), length of stay (LOS), and improved patient satisfaction. There are no studies evaluating the use of ERAS in pediatric and adolescent gynecology (PAG). The goals of this study are to present initial patient outcomes using ERAS in PAG patients undergoing intra-abdominal gynecologic surgery to prove efficacy, patient satisfaction, and decreased narcotic use.
Design:
As a quality improvement measure in perioperative care, an ERAS protocol including preoperative, intraoperative, and postoperative components and a follow-up patient telephone call for pain assessment was implemented for all intra-abdominal gynecologic procedures. A retrospective study on implementation of ERAS components, outcomes, and patient satisfaction was then performed in participants meeting inclusion criteria.
Setting:
Large academic children's hospital.
Participants:
Patients <25 years of age who underwent laparoscopic (LSC) or open abdominal (XLAP) gynecologic surgery using an ERAS protocol by the PAG service over a 12-month period.
Interventions:
An ERAS protocol including preoperative, intraoperative, and postoperative components and follow-up patient telephone call for pain assessment was implemented for all major gynecologic surgeries performed by the PAG service.
Main Outcome Measures:
Patient satisfaction with the perioperative ERAS protocol along with components including pain management, narcotic use, LOS, RTS, and postoperative complications for various intra-abdominal gynecologic procedures.
Results:
A total of 40 participants met inclusion criteria for the study. Thirty-four (85%) participants underwent LSC procedures and six (15%) underwent XLAP. Of the LSC patients, 95% were discharged on postoperative day 0, and all XLAP patients and one LSC patient were discharged on postoperative day 1. In all, 95% of patients were discharged from the hospital requiring only non-narcotic ERAS medications. There were no readmissions or postoperative complications. All patients were satisfied with their postoperative pain control at their follow-up telephone call and clinic visit.
Conclusion:
Implementation of a pediatric-specific ERAS protocol in children and adolescents undergoing gynecologic surgery is feasible and safe, and leads to less narcotic use without an increase in complications or decrease in patient satisfaction.
