Enhanced Recovery after Surgery: Benefits for the Fetal Surgery Patient

Area of Science:

• Maternal-fetal medicine
• Minimally invasive surgery
• Neonatal surgery

Background:

• Fetoscopic approach for prenatal neural tube defect (NTD) closure offers maternal benefits over open repair.
• Enhanced Recovery After Surgery (ERAS) protocols optimize surgical patient recovery.
• This study adapted ERAS principles for in utero myelomeningocele repair.

Purpose of the Study:

• To evaluate the impact of an ERAS protocol on postoperative length of stay (LOS) after fetoscopic NTD repair.
• To assess secondary outcomes including pain, oral intake, and respiratory complications.
• To compare ERAS protocol outcomes against traditional perioperative management.

Main Methods:

• Retrospective study of 30 patients undergoing mid-gestation fetoscopic NTD closure.
• Data collected included demographics, comorbidities, LOS, and various perioperative parameters.
• Patients were divided into traditional management (20) and ERAS protocol (10) groups for comparison using statistical tests.

Main Results:

• ERAS protocol group showed a significantly reduced LOS (112.5 ± 12.6 h) compared to the traditional group (179.7 ± 87.9 h).
• Time to oral intake was shorter in the ERAS group (502.6 ± 473.4 min) versus the traditional group (1015.6 ± 698.2 min).
• ERAS patients had lower oxygen requirements and shorter magnesium sulfate infusion durations; pain scores were similar between groups.

Conclusions:

• An ERAS protocol is feasible for fetoscopic in utero repair of NTDs.
• ERAS implementation leads to decreased postoperative LOS and earlier oral intake.
• The protocol reduces oxygen needs and magnesium sulfate infusion duration without compromising pain management.