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A Comparison of Adult and Pediatric Enhanced Recovery after Surgery Pathways: A Move for Standardization
Kathleen Marulanda1, Laura N Purcell1, Paula D Strassle1
1Department of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina.
Insights
Pediatric enhanced recovery protocols (pERP) show benefits in colorectal surgery, reducing opioid use and returns to the operating room. A synthesized pathway combines pERP and adult ERP (aERP) elements for optimized care.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Perioperative Medicine
Background:
- Enhanced Recovery Protocols (ERP) standardize perioperative care.
- Pediatric-centered ERP (pERP) pathways aim to improve outcomes for children.
- Comparing pERP with adult ERP (aERP) is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To compare outcomes of pediatric colorectal surgery patients managed with pERP versus aERP.
- To identify components for a comprehensive pediatric ERP to reduce care variation.
Main Methods:
- Retrospective study of children (≤18 years) undergoing elective colorectal surgery.
- Comparison of outcomes between pERP and aERP pathways.
- Multivariable regression analysis adjusting for demographics and operative characteristics.
Main Results:
- pERP patients were younger and more likely to receive regional/neuraxial anesthesia.
- Epidural use was linked to longer length of stay (LOS).
- pERP patients had similar LOS and time to oral intake, shorter Foley duration, significantly fewer opioids, and fewer 30-day returns to the operating room.
Conclusions:
- A synthesized pathway integrating pERP and aERP elements is beneficial.
- The pERP approach effectively reduces opioid utilization.
- The aERP approach supports earlier enteral nutrition.
Background:
Enhanced recovery protocols (ERP) are a multimodal approach to standardize perioperative care. To substantiate the benefit of a pediatric-centered pathway, we compared outcomes of children treated with pediatric ERP (pERP) versus adult (aERP) pathways. We aimed to compare components of each pathway to create a new comprehensive pERP to reduce variation in care.
Methods:
Retrospective study of children (≤18 y) undergoing elective colorectal surgery from August 2015 to April 2019 at a single institution managed with pERP versus aERP. Multivariable linear and logistic regression, adjusting for demographics and operation characteristics, were used to compare outcomes.
Results:
Out of 100 hospitalizations (72 patients) were identified, including 37 treated with pERP. pERP patients were, on average, younger (13 versus 16 y), more likely to be ASA III (70% versus 30%), and more likely to receive regional (32% versus 3%) or neuraxial (35% versus 8%) anesthesia. Epidural use was an independent risk factor for longer length of stay (P = 0.000). After adjustment, pERP patients had similar LOS and time to oral intake, but shorter foley duration. pERP patients used significantly fewer opioids and were less likely to return to the operating room within 30 d. 30-d readmissions and ED visits were also lower, but this was not statistically significant.
Conclusions:
At our institution, data from both ERPs contributed formation of a synthesized pathway and reflected the pERP approach to opioid utilization and the aERP approach to earlier enteral nutrition.
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