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Utilization of an Enhanced Recovery After Surgery (ERAS) protocol for pediatric metabolic and bariatric surgery
Wendy Jo Svetanoff1, Karen Diefenbach1, Brian Hall2
1Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
Insights
Enhanced recovery after surgery (ERAS) protocols significantly reduced narcotic use and hospital stays in pediatric bariatric surgery patients. This approach improved recovery times without increasing adverse events.
Area of Science:
- Pediatric Surgery
- Metabolic Surgery
- Enhanced Recovery After Surgery (ERAS) Protocols
Background:
- ERAS protocols are underutilized in pediatric metabolic and bariatric surgery.
- An ERAS protocol was implemented for robotically assisted vertical sleeve gastrectomy (r-VSG) in 2018.
- This study evaluates outcomes before and after ERAS implementation.
Purpose of the Study:
- To compare in-hospital and 30-day outcomes in pediatric patients undergoing r-VSG before and after ERAS protocol initiation.
- To assess the impact of ERAS on narcotic utilization, postoperative nausea, and length of stay.
- To evaluate the safety and efficacy of ERAS in this patient population.
Main Methods:
- Retrospective review of 110 patients undergoing r-VSG (July 2015-July 2021).
- Patients divided into non-ERAS (n=60) and ERAS (n=50) groups.
- Comparison of in-hospital and 30-day outcomes, focusing on narcotic use, oral intake, and length of stay.
Main Results:
- The ERAS group showed significantly decreased narcotic use and earlier time to oral intake (proxy for nausea/vomiting).
- Hospital length of stay was significantly shorter in the ERAS group.
- No significant difference in adverse events, including post-discharge dehydration, was observed between groups.
Conclusions:
- ERAS protocol implementation led to reduced narcotic utilization, faster oral intake, and shorter hospital stays in pediatric bariatric surgery.
- The ERAS protocol was associated with no increase in adverse events.
- Further research with larger studies is recommended to analyze healthcare utilization.
Introduction:
Enhanced recovery after surgery (ERAS) protocols for pediatric metabolic and bariatric surgery are limited. In 2018, an ERAS protocol for patients undergoing robotically assisted vertical sleeve gastrectomy (r-VSG) was instituted. This study's aim was to compare outcomes before and after ERAS initiation.
Methods:
A single institution retrospective review of patients undergoing r-VSG from July 2015 to July 2021 was performed. The multimodal ERAS protocol focused on limiting post-operative nausea and narcotic utilization. Subjects were categorized into non-ERAS (July 2015-July 2018) and ERAS (August 2018-July 2021) groups. In-hospital and 30-day outcomes were compared.
Results:
110 subjects (94 females) with a median age of 17.6 years (range 12.5-22.0 years) were included (60 non-ERAS, 50 ERAS). Demographics were similar except for a higher proportion of females in the non-ERAS group (97% vs 72%, p < 0.001). A significant decrease in narcotic use (p < 0.001) and higher utilization of acetaminophen (p < 0.001) and ketorolac (p < 0.001) was observed in the ERAS group. Additionally, median time to oral intake, a proxy for postoperative nausea and vomiting [2:00 h (1:15, 2:30) vs. 3:22 h (2:03, 6:15), p < 0.001] and hospital length of stay (LOS) [1.25 days (1.14, 1.34) vs. 2.16 days (1.48, 2.42), p < 0.001] were shorter in the ERAS group. Eleven subjects (10%; ERAS = 5, non-ERAS = 6) experienced post-discharge dehydration, prompting readmission 8 times for 7 (6%) individuals.
Conclusion:
Utilization of ERAS led to a significant decrease narcotic utilization, time to first oral intake, and hospital LOS with no change in adverse events following pediatric metabolic and bariatric surgery. Larger studies, including comparative analysis of health care utilization, should be carried out.
Level Of Evidence:
III.
Type Of Study:
Treatment Study.
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