Implementing Change: Sustaining Enhanced Recovery After Surgery Protocols in Pediatric Surgery Using Iterative...

Area of Science:

• Pediatric Surgery
• Surgical Protocols
• Implementation Science

Background:

• Enhanced Recovery After Surgery (ERAS) protocols are increasingly adopted in pediatric surgery.
• Limited data exists on ERAS protocol compliance and sustainability in this population.

Purpose of the Study:

• To prospectively evaluate the compliance and impact of an ERAS protocol for pediatric pectus repair.
• To compare outcomes with a historical control group.

Main Methods:

• Prospective observational study at a children's hospital.
• Evaluated overall ERAS protocol compliance at 1 year postimplementation.
• Compared outcomes to 2 years of historical pectus repair data.

Main Results:

• Overall ERAS protocol compliance reached 89% at 12 months.
• Significantly increased use of preoperative acetaminophen and gabapentin compared to controls.
• Reduced time to normal diet postoperatively (0.53 days vs. 1.16 days).
• No significant difference in readmission rates.

Conclusions:

• ERAS protocol compliance is variable across different care phases.
• Sustaining ERAS protocols requires institutional tailoring and patient population considerations.
• Implementation science is crucial for identifying and addressing compliance gaps.