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Implementation of an Enhanced Recovery After Surgery Protocol for Cleft Palate Repair
Samuel J Hopper1, Colton J Fernstrum, John B Phillips
1From the University of Mississippi Medical Center, Jackson, MS.
Insights
The Enhanced Recovery After Surgery (ERAS) protocol significantly reduced hospital stays and narcotic use in cleft palate patients. This approach offers a promising strategy for improving surgical recovery and patient outcomes.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pain Management
Background:
- Cleft palate repair is a common pediatric surgical procedure.
- Optimizing postoperative recovery, including pain management and length of hospital stay, is crucial for patient well-being.
- Enhanced Recovery After Surgery (ERAS) protocols aim to standardize and improve perioperative care.
Purpose of the Study:
- To evaluate the effectiveness of an Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing cleft palate repair.
- To determine if adherence to the ERAS protocol is associated with reduced hospital length of stay and decreased narcotic consumption postoperatively.
- To compare outcomes between patients who followed the ERAS protocol and those who did not.
Main Methods:
- Retrospective cohort study including 242 patients who underwent cleft palate repair over a 10-year period at a tertiary children's hospital.
- Comparison of outcomes between a cohort that followed a new ERAS protocol and a historical cohort that did not.
- Primary outcome measures included hospital length of stay and narcotic usage within the first 24 hours after surgery.
Main Results:
- Utilization of the ERAS protocol was associated with a significant decrease in hospital length of stay (1.67 vs 2.18 days, P < 0.01).
- Patients on the ERAS protocol showed reduced 24-hour morphine equivalent usage (6.3 MME post-implementation vs 24.53 MME prior).
- Intraoperative use of local bupivacaine correlated with decreased 24-hour morphine equivalent usage (2.25 vs 3.38 mg MME) and shorter hospital stays (1.71 vs 2.27 days).
Conclusions:
- The implemented Enhanced Recovery After Surgery (ERAS) protocol appears effective in reducing narcotic requirements and hospital length of stay for pediatric cleft palate repair patients.
- The findings suggest that ERAS protocols can optimize postoperative pain management and facilitate earlier discharge.
- Further investigation into specific ERAS components, such as local anesthetic use, may yield further improvements in surgical recovery.
Objective:
This study examines an Enhanced Recovery After Surgery (ERAS) protocol for patients with cleft palate and hypothesizes that patients who followed the protocol would have decreased hospital length of stay and decreased narcotic usage than those who did not.
Design:
Retrospective cohort study.
Setting:
The study takes place at a single tertiary children's hospital.
Patients:
All patients who underwent cleft palate repair during a 10-year period (n = 242).
Interventions:
All patients underwent cleft palate repair with the most recent cohort following a new ERAS protocol.
Main Outcome Measures:
Primary outcomes included hospital length of stay and narcotic usage in the first 24 hours after surgery.
Results:
Use of local bupivacaine during surgery was associated with decreased initial 24-hour morphine equivalent usage: 2.25 vs 3.38 mg morphine equivalent (MME) (P < 0.01), and a decreased hospital length of stay: 1.71 days vs 2.27 days (P < 0.01). The highest 24-hour morphine equivalent a patient consumed prior to the ERAS protocol implementation was 24.53 MME, compared with 6.3 MME after implementation. Utilization of the ERAS protocol was found to be associated with a decreased hospital length of stay: 1.67 vs 2.18 days (P < 0.01).
Conclusions:
Use of the proposed ERAS protocol may lead to lower narcotic usage and decreased length of stay.
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