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Feasibility of Enhanced Recovery after Surgery in Pediatric Colostomy Reversal
M N S Uday Bhaskar1, Lakshmi Sundararajan1
1Department of Paediatric Surgery, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.
Insights
Enhanced recovery after surgery (ERAS) pathways significantly reduce hospital stays and complications for pediatric colostomy reversals. This study demonstrates ERAS is feasible and beneficial in children, improving surgical outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Enhanced Recovery Pathways
Background:
- Enhanced Recovery After Surgery (ERAS) protocols optimize perioperative care, improving patient outcomes.
- While ERAS has shown success in adults and some pediatric cases, its application in pediatric colostomy reversal warrants further investigation.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of ERAS pathways for pediatric colostomy reversal.
- To compare outcomes of ERAS with traditional care pathways (TCP) in pediatric patients undergoing colostomy reversal.
Main Methods:
- A retrospective analysis of 48 pediatric patients undergoing colostomy reversal between May 2016 and 2019.
- ERAS protocol included avoiding mechanical bowel preparation, early feeding, and multimodal pain management.
- Outcomes compared included length of hospital stay (LOS) and complication rates between ERAS (13 cases) and TCP (35 cases).
Main Results:
- The ERAS group experienced a significantly shorter mean LOS of 3.7 days compared to 7.2 days in the TCP group.
- Complication rates were lower in the ERAS group (1/13) versus the TCP group (9/35), with no operative interventions required for complications.
- Anti-emetic use was minimal in the ERAS group (1/13).
Conclusions:
- ERAS pathways are feasible and effective for pediatric colostomy reversal, leading to reduced length of stay and fewer complications.
- Successful implementation requires comprehensive education for all healthcare personnel involved in pediatric surgical care.
- ERAS offers a valuable approach to improving outcomes in pediatric surgical patients.
Aim:
Enhanced recovery after surgery (ERAS) are multimodal perioperative pathways that have shown improved outcomes. ERAS after colostomy reversal has shown promising results in adults and few pediatric studies. We report our experience using ERAS for a colostomy reversal.
Materials And Methods:
A retrospective analysis of children in whom ERAS was used during colostomy reversal between May 2016 and 2019 was carried out. ERAS protocol in our study included avoiding mechanical bowel preparation (MBP), oral liquid diet upto 3 h preoperatively, usage of regional anesthesia, minimal handling of bowel intraoperatively, using nonopioid analgesics for pain relief, early initiation of feeding on the first postoperative day, early discharge once full feeds are established. Outcomes analyzed are the duration of hospital stay and complications, including readmissions. Requirement for opioids and anti-emetics are noted. The outcomes are compared with traditional care pathways (TCP), which use MBP, overnight fasting, opioid analgesia, and delayed feeding. A total of 48 are included in the study, with 13 cases using ERAS and TCP in 35 cases.
Statistical Analysis Used:
Nonparametric Mann-Whitney U-test was used.
Results:
In the ERAS group, the mean length of hospital stay (LOS) postoperatively was 3.7 days (2-5 days) as opposed to 7.2 days (5-11 days) in TCP. There was only one child with complications in the ERAS group, while 9 cases in TCP had complications, though none of them required operative intervention. There was the requirement of anti-emetic in only one child in the ERAS group.
Conclusion:
ERAS for colostomy reversal is feasible in the pediatric population. For successful implementation, all personnel involved in the care of the child need to be educated about the protocol. It reduces LOS and complications.
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