Providers' Perceptions Versus Practices Inform Pediatric Colorectal Enhanced Recovery After Surgery Implementation

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Surgical Outcomes

Background:

• Enhanced Recovery After Surgery (ERAS) pathways aim to optimize patient recovery.
• Barriers to ERAS implementation often stem from discrepancies in perceived versus actual clinical practices.
• Understanding these gaps is crucial for successful ERAS protocol adoption.

Purpose of the Study:

• To compare surgeon and anesthesia perceptions with current practices before initiating an ERAS protocol in pediatric colorectal surgery.
• To identify specific barriers to ERAS implementation based on this comparison.
• To inform the development and refinement of ERAS protocols for pediatric patients.

Main Methods:

• A mixed-methods, single-institution study involving pediatric colorectal surgery.
• Surveys administered to anesthesiologists and surgeons to assess perceptions of ERAS components.
• Retrospective and prospective chart reviews of pediatric patients (5-18 years) undergoing colorectal procedures.

Main Results:

• Preoperative non-opioid analgesic and regional anesthesia use was low.
• Intraoperative care showed suboptimal fluid balance and normothermia.
• Postoperative care, including feeding and mobilization, often deviated from ideal ERAS guidelines, with significant improvements noted in non-opioid analgesia and antiemetic use post-implementation.
• Length of stay remained unchanged.

Conclusions:

• Discrepancies between perceived and actual practices present significant barriers to ERAS implementation.
• Assessing these differences is essential for tailoring and successfully implementing ERAS protocols.
• Targeted interventions can improve adherence to ERAS components, though further optimization is needed.