So many measures in ERAS protocol: Which matters most?

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Enhanced Recovery After Surgery (ERAS) Protocols

Background:

• Enhanced Recovery After Surgery (ERAS) is standard perioperative care in pediatric surgery.
• The impact of individual ERAS measures on outcomes remains unclear.

Purpose of the Study:

• To identify which ERAS measures most significantly affect postoperative length of stay (PLOS) in children with congenital choledochal cysts.
• To analyze the association between baseline factors, ERAS interventions, and PLOS.

Main Methods:

• Retrospective analysis of 219 pediatric patients with congenital choledochal cysts (Jan 2019-Dec 2022).
• Collected data on baseline factors, ERAS implementation, complications, and PLOS.
• Performed univariate and multivariate analyses to determine factors influencing PLOS.

Main Results:

• Early postoperative feeding and early tube removal were identified as the most impactful ERAS measures for reducing PLOS.
• Postoperative complications, poor preoperative nutritional status, and elevated liver function indexes were associated with prolonged PLOS.
• Multivariate analysis confirmed the significant influence of complications, early feeding, and early catheter removal on PLOS.

Conclusions:

• Prolonged PLOS in pediatric choledochal cyst surgery is linked to preoperative nutritional status, liver function, and complications.
• Implementing early postoperative feeding and early tube removal are crucial ERAS strategies for reducing PLOS.