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Development of an enhanced recovery after surgery program for pediatric solid tumors
Sara A Mansfield1,2, Meera Kotagal3, Stephen Hartman3
1Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States.
Insights
This study evaluates the feasibility of Enhanced Recovery After Surgery (ERAS) protocols for pediatric patients undergoing abdominal tumor resections. The research aims to improve surgical outcomes and recovery for young cancer patients.
Area of Science:
- Pediatric Surgical Oncology
- Evidence-Based Medicine
- Peri-operative Care
Background:
- Enhanced Recovery After Surgery (ERAS) is a multimodal approach to reduce surgical stress and improve outcomes.
- ERAS is increasingly adopted in pediatric surgery, but its application in abdominal tumor resections is not well-established.
- Pediatric abdominal tumor resections involve complex procedures with variable patient needs.
Purpose of the Study:
- To evaluate the feasibility of an ERAS protocol for pediatric patients undergoing abdominal tumor resections.
- To assess the safety and efficacy of ERAS in this specific patient population.
- To inform the development and implementation of ERAS programs in pediatric surgical oncology.
Main Methods:
- A multi-center, prospective, propensity-matched case-control study was designed.
- An ERAS protocol was developed by key stakeholders for pediatric abdominal solid tumor resections.
- A pilot phase preceded patient enrollment, with primary outcome being 90-day complications.
Main Results:
- The study is currently ongoing, with data collection and analysis planned.
- Expected results will assess ERAS protocol adherence, length of stay, and patient-reported outcomes.
- Secondary outcomes include readmissions, reoperations, and pain management.
Conclusions:
- The findings are expected to guide peri-operative care for pediatric surgical oncology patients.
- This study will provide evidence for the initiation and optimization of ERAS programs in this field.
- Successful implementation of ERAS may lead to improved recovery and outcomes for children undergoing major abdominal surgery.
Introduction:
Enhanced recovery after surgery (ERAS) is an evidence-based, multi-modal approach to decrease surgical stress, expedite recovery, and improve postoperative outcomes. ERAS is increasingly being utilized in pediatric surgery. Its applicability to pediatric patients undergoing abdominal tumor resections remains unknown.
Methods And Analysis:
A group of key stakeholders adopted ERAS principles and developed a protocol suitable for the variable complexity of pediatric abdominal solid tumor resections. A multi-center, prospective, propensity-matched case control study was then developed to evaluate the feasibility of the protocol. A pilot-phase was utilized prior to enrollment of all patients older than one month of age undergoing any abdominal, retroperitoneal, or pelvic tumor resections. The primary outcome was 90-day complications per patient. Additional secondary outcomes included: ERAS protocol adherence, length of stay, time to administration of adjuvant chemotherapy, readmissions, reoperations, emergency room visits, pain scores, opioid usage, and differences in Quality of Recovery 9 scores.
Ethics And Dissemination:
Institutional review board approval was obtained at all participating centers. Informed consent was obtained from each participating patient. The results of this study will be presented at pertinent society meetings and published in peer-reviewed journals. We expect the results will inform peri-operative care for pediatric surgical oncology patients and provide guidance on initiation of ERAS programs. We anticipate this study will take four years to meet accrual targets and complete follow-up.
Trial Registration Number:
NCT04344899.
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