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Implementation and outcomes of enhanced recovery protocols in pediatric surgery: a systematic review and
Arun Kumar Loganathan1, Anita Shirley Joselyn2, Malavika Babu3
1Department of Pediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, 632002, India.
Insights
Enhanced recovery after surgery (ERAS) protocols are feasible and safe for children, significantly reducing hospital stays and opioid use without increasing complications. Parental satisfaction also improved with early feeding and reduced interventions.
Area of Science:
- Pediatric Surgery
- Perioperative Care
- Evidence-Based Medicine
Background:
- Enhanced Recovery After Surgery (ERAS) protocols aim to optimize surgical patient recovery.
- Implementation of ERAS in pediatric populations is under investigation for feasibility and safety.
Purpose of the Study:
- To systematically review and meta-analyze the feasibility and safety of ERAS protocols in pediatric patients.
- To evaluate the impact of ERAS on recovery outcomes, including nutrition, pain management, and length of stay.
Main Methods:
- Systematic literature search of Medline, PubMed, and Cochrane Library (January 2000 - January 2021).
- Meta-analysis of 16 studies involving 1723 pediatric patients, adhering to PRISMA guidelines.
- Statistical analysis performed using R Software, with p < 0.05 considered significant.
Main Results:
- High compliance (84%) with an average of 15 ERAS components implemented.
- Significant reductions in time to initiate feeds (MD -21.20 h) and reach full enteral nutrition (MD -2.20 days).
- Reduced opioid use (MD -0.86 morphine equivalents mg/kg) and length of hospital stay (MD -2.54 days) with no increase in complications or readmissions.
Conclusions:
- ERAS protocols are a viable option in pediatric perioperative care across various surgical settings.
- ERAS implementation leads to shorter hospital stays without compromising safety.
- Increased parental satisfaction is associated with early enteral feeding, minimized invasive interventions, and reduced opioid consumption.
Background:
This systematic review examines the feasibility and safety of implementing Enhanced recovery after Surgery (ERAS) protocols in children.
Study Design:
A systematic search of Medline, PubMed, and the Cochrane library for papers describing ERAS implementation in children between January 2000 and January 2021. The systematic review was performed according to the PRISMA statement. The meta-analysis was done using R Software (Ver 4.0.2). p value of < 0.05 was considered statistically significant.
Results:
Sixteen studies, describing a total of 1723 patients, were included in the meta-analysis. An average of 15 (range 11-16) relevant components were implemented with an overall compliance close to 84%. The time to initiate feeds and reach full enteral nutrition was reduced in ERAS group with mean difference (MD) of - 21.20 h (95% CI - 22.80, - 19.59, p < 0.01), and - 2.20 days (95% CI - 2.72, - 1.71, p < 0.01), respectively. The use of opioids for postoperative analgesia was reduced with MD of -0.86 morphine equivalents mg/kg (95% CI - 1.40, - 0.32, p < 0.01). The length of hospital stay showed a significant reduction with MD of -2.54 days (95% CI - 2.94, - 2.13, p < 0.01). There was no difference in the complication and readmission rates between the groups.
Conclusion:
ERP implementation in pediatric perioperative care is a viable option in a variety of surgical settings. There is clear evidence of a decrease in hospital stay duration with no increase in complication or readmission rates. The length of hospital stay reduced in inverse proportion to the number of ERAS elements implemented. Parental satisfaction is increased by initiating enteral feeding early, minimizing catheter and drain use, and reducing opioid use.
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