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Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay

Rebecca Knackstedt1, Niyant Patel2

  • 1Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.

Plastic and Reconstructive Surgery. Global Open
|November 11, 2020
PubMed

Insights

Enhanced recovery after surgery (ERAS) protocols for fronto-orbital advancement (FOA) significantly reduced blood transfusions and narcotic use. This approach also decreased hospital length of stay, improving recovery for children with craniosynostosis.

Area of Science:

  • Pediatric surgery
  • Craniofacial surgery
  • Enhanced recovery after surgery (ERAS) protocols

Background:

  • Enhanced recovery after surgery (ERAS) protocols are multi-modal strategies to reduce patient morbidity, opioid consumption, and hospital stays.
  • In 2013, modifications were implemented in the perioperative care for pediatric patients undergoing complex craniofacial procedures.
  • This study aimed to evaluate the effectiveness of our ERAS protocol in children undergoing fronto-orbital advancement (FOA) for craniosynostosis.

Purpose of the Study:

  • To analyze the outcomes of an ERAS protocol for pediatric patients undergoing fronto-orbital advancement (FOA).
  • To assess the impact of the ERAS protocol on blood transfusion rates, narcotic utilization, and length of hospital stay.
  • To determine the safety and efficacy of the multimodal ERAS approach in complex craniofacial surgery recovery.

Main Methods:

  • A retrospective chart review was conducted for pediatric patients who underwent FOA for craniosynostosis between 2010 and 2018, post-IRB approval.
  • The ERAS protocol, implemented in December 2013, included hemoglobin optimization, cell-saver technology, tranexamic acid, precise postoperative fluid management, and a defined transfusion algorithm.
  • Analgesia focused on minimizing narcotics through scheduled acetaminophen, ibuprofen, or ketorolac, supplemented by dexmedetomidine, with opioids reserved for breakthrough pain.

Main Results:

  • The ERAS group (55 patients) showed a significantly lower rate and volume of intraoperative transfusions compared to the control group (23 patients) (13/53 vs. 23/23, P < 0.0001; 183.4 mL vs. 339.8 mL, P = 0.05).
  • Fewer ERAS patients required morphine/dilaudid (12/55 vs. 22/23, P < 0.0001), with reduced doses needed for those requiring it (2.8 vs. 11, P = 0.02).
  • ERAS patients experienced a shorter hospital stay (2.3 vs. 3.6 nights, P < 0.0001) with no readmissions for common postoperative concerns.

Conclusions:

  • The implemented ERAS protocol effectively reduced allogeneic blood transfusion rates, narcotic consumption, and hospital length of stay in pediatric FOA patients.
  • The multimodal ERAS approach proved to be safe and effective for managing recovery after complex craniofacial surgery.
  • This study supports the use of ERAS protocols in pediatric craniofacial surgery to optimize patient outcomes.
Abstract

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