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Baseline assessment of enhanced recovery after pediatric surgery in mainland China
Nan Xie1, Hua Xie1, Weibing Tang2
1Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210000, Jiangsu Province, China.
Insights
Enhanced recovery after surgery (ERAS) implementation in China shows variability, with a mean of 10.23 elements adopted. Key areas like pain and nausea management require improvement for better pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Clinical Pathways
- Evidence-Based Medicine
Background:
- Enhanced Recovery After Surgery (ERAS) optimizes perioperative care using evidence-based practices.
- ERAS is increasingly adopted in pediatric surgery, but implementation data is scarce.
- This study assesses ERAS protocol assimilation in Chinese pediatric surgery for congenital biliary dilatation (CBD).
Purpose of the Study:
- To determine the current implementation status of ERAS protocols in pediatric surgery centers in mainland China.
- To identify the extent of ERAS element adoption for congenital biliary dilatation (CBD) patients.
- To understand barriers to ERAS implementation in this setting.
Main Methods:
- A questionnaire survey was developed focusing on 17 key ERAS elements.
- The survey was distributed to 66 pediatric surgery chiefs across 31 provinces in mainland China.
- Data collected provided a baseline assessment of ERAS protocol assimilation.
Main Results:
- A total of 66 questionnaires were analyzed, with 4-16 ERAS elements implemented per center (mean 10.23).
- Least implemented elements included preoperative non-opioid analgesia (9.09%), PONV prevention (13.64%), and postoperative pain management (39.39%).
- Significant variation in ERAS element adoption was observed across centers.
Conclusions:
- ERAS element implementation varies significantly among Chinese pediatric surgery centers.
- Lower adherence was noted for elements primarily managed by anesthesiologists.
- Barriers include lack of institutional support, insufficient ERAS knowledge, multidisciplinary coordination challenges, and resistance to practice change.
Background:
Enhanced recovery after surgery (ERAS) is a clinical pathway that optimizes perioperative management based on evidence-based medicine. ERAS has been gradually introduced to pediatric surgery in recent years. However, there are limited reports on its overall implementation. We aimed to determine the implementation of ERAS in patients who received pediatric surgery in mainland China.
Methods:
We designed a questionnaire involving 17 key ERAS elements and sent the questionnaire to 66 chiefs of pediatric surgery distributed throughout 31 provinces in mainland China to obtain a baseline assessment of the assimilation of ERAS protocols in the care of congenital biliary dilatation (CBD).
Results:
A total of 66 questionnaires were collected. The range of elements implemented at participating centers was 4-16, with a mean of 10.23. The least commonly practiced elements were administration of non-opioid preoperative analgesia (6 centers, 9.09%), prevention of postoperative nausea and vomiting [PONV] (9 centers, 13.64%), and postoperative pain management (26 centers, 39.39%).
Conclusions:
The implementation of elements differed from center to center. Measures relying primarily on anesthesiologists had lower execution. The adherence to ERAS elements was often inhibited by a lack of institutional support, poor knowledge of ERAS protocols, and difficulties in coordinating multidisciplinary care, as well intransigence in changing surgical practices out of fear of liability for poor outcomes.
