So many measures in ERAS protocol: Which matters most?
1Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
Insights
Enhanced recovery after surgery (ERAS) protocols in pediatric choledochal cyst surgery show that early postoperative feeding and early tube removal significantly reduce hospital stays. Attention to these ERAS measures is key for better patient outcomes.
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.
Objectives:
Enhanced recovery after surgery (ERAS), which includes multiple measures, has gradually become the standard perioperative management in pediatric surgery. However, it is still unclear which of its many measures affects the outcomes more.
Methods:
We retrospectively analyzed the medical records of children with congenital choledochal cysts who underwent surgical treatment in a specialized children's hospital from January 2019 to December 2022. Data including baseline factors, implementation of ERAS interventions, postoperative complications, and postoperative length of stay (PLOS) were collected. Univariate and multivariate analyses were performed to identify the association between PLOS and baseline factors or specific ERAS measures.
Results:
The implementation rate of ERAS measures ranged from 5.02% to 100% in 219 cases who underwent 3 to 14 ERAS measures. Univariate analysis showed that body mass index-for-age z-scores, liver function indicators, and postoperative complications were the significant baseline factors for PLOS. At the same time, the measures with the greatest effect on PLOS were early postoperative feeding and early removal of tubes. Multivariate analysis with different models revealed that postoperative complications, early postoperative feeding, and early catheter removal influenced the PLOS the most.
Conclusions:
A prolonged PLOS was associated with poor preoperative nutritional status, elevated liver function indexes, and postoperative complications. Early postoperative feeding and removal of tubes appeared more likely with a reduced PLOS than other measures, requiring more attention when implementing the ERAS protocol.
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