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The impact of an enhanced recovery perioperative pathway for pediatric pectus deformity repair
Sabrina Mangat1, Lyla Hance2, Karene J Ricketts2
1Division of Pediatric Surgery, Department of Surgery, University of North Carolina CB 7223, Chapel Hill, NC, 27599, USA.
Insights
Implementing an enhanced recovery after surgery (ERAS) pathway for pediatric chest wall repair standardized care but did not reduce opioid use or resource utilization. Further protocol adjustments are needed for improved pain management and efficiency.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Surgical outcomes
Background:
- Pediatric chest wall deformity repair involves significant pain and resource use.
- Minimally invasive (Nuss) and traditional (Ravitch) procedures are common.
- Enhanced recovery after surgery (ERAS) pathways aim to optimize perioperative care.
Purpose of the Study:
- To evaluate the outcomes of a perioperative ERAS pathway for pediatric chest wall deformity repair.
- To compare outcomes between Nuss and Ravitch procedures before and after ERAS implementation.
Main Methods:
- Retrospective review of patients undergoing Nuss or Ravitch procedures.
- Comparison of outcomes before and after ERAS protocol implementation in 2015.
- Bivariate analyses of postoperative outcomes and resource utilization.
Main Results:
- ERAS protocol increased pre-operative non-narcotic medication use.
- Post-ERAS Nuss procedures showed decreased epidural duration and faster enteral medication initiation, but increased opioid use.
- Post-ERAS Ravitch procedures had reduced intra-operative narcotics and lower discharge pain scores.
- No significant differences in length of stay or complications were observed.
Conclusions:
- The ERAS protocol standardized perioperative care for pectus repair but did not improve opioid usage, complications, or resource utilization.
- Modifications to the ERAS protocol may be necessary to achieve better pain control and reduced resource use.
Purpose:
Pediatric repair of chest wall deformities is associated with significant pain, morbidity, and resource utilization. We sought to determine outcomes of a perioperative enhanced recovery after surgery (ERAS) pathway for patients undergoing minimally invasive (Nuss) and traditional (Ravitch) corrective procedures.
Methods:
Our ERAS protocol was implemented in 2015. We performed a retrospective review of patients for Nuss or Ravitch procedures before and after ERAS implementation. Combined and procedure segregated bivariate analyses were conducted on postoperative outcomes and resource utilization.
Results:
There are 17 patients in the pre-intervention group (Nuss = 13 and Ravitch = 4) compared to 38 patients in the post-intervention group (Nuss = 28 and Ravitch = 10). Protocol implementation increased utilization of pre-operative non-narcotic medication. The combined and Nuss post-intervention groups had a significant decrease in epidural duration and time to enteral medications, but had increased total postoperative opioid usage. The Ravitch post-intervention group had a significant decrease in intra-operative narcotics and discharge pain scores. There were no differences in length of stay or complications.
Conclusion:
Implementation of our ERAS protocol standardized pectus perioperative care, but did not improve postoperative opioid usage, complications, or resource utilization. Alterations in the protocol may lead to achieving desired goals of better pain management and decreased resource utilization.
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