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Effect of enhanced recovery after surgery on postoperative outcomes in children undergoing robot-assisted
Jun Pei1, Shili Wang1, Xingyu Pan1
1Department of Pediatric Surgrey, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
Insights
The enhanced recovery after surgery (ERAS) protocol significantly shortens hospital stays and improves gastrointestinal recovery in children undergoing robot-assisted laparoscopic pyeloplasty (RALP). ERAS also reduces complications and pain in older children.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Perioperative Medicine
Background:
- Robot-assisted laparoscopic pyeloplasty (RALP) is a minimally invasive procedure for pediatric urinary tract conditions.
- Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery and reduce surgical stress.
- The application of ERAS in pediatric RALP requires further investigation to confirm its benefits.
Purpose of the Study:
- To evaluate the impact of the ERAS perioperative protocol on outcomes in pediatric patients undergoing RALP.
- To compare key recovery metrics between ERAS and traditional perioperative care groups.
- To assess the effect of ERAS on pain severity in different pediatric age groups.
Main Methods:
- A prospective randomized controlled trial involving 57 children undergoing RALP.
- Patients were assigned to either an ERAS (intervention) or non-ERAS (control) group.
- Outcomes assessed included hospital stay, gastrointestinal function, complications, extubation times, and pain severity by age.
Main Results:
- No significant differences in preoperative or intraoperative parameters were observed between groups.
- The ERAS group demonstrated a significantly shorter hospital stay and faster gastrointestinal function recovery.
- ERAS significantly reduced postoperative complications and pain in children aged 4 years and older.
Conclusions:
- The ERAS protocol is effective in improving postoperative outcomes for pediatric RALP.
- ERAS reduces hospital stay, enhances gastrointestinal recovery, and lowers complication rates.
- ERAS offers significant benefits in pain management for older pediatric patients undergoing RALP.
Objective:
To assess the effects of the enhanced recovery after surgery (ERAS) perioperative protocol on the outcomes of robot-assisted laparoscopic pyeloplasty (RALP) in pediatric patients.
Methods:
A total of 57 children who underwent RALP at our center between November 2021 and December 2023 were included in the study. They were randomly assigned to either the ERAS (intervention) group or the non-ERAS (control) group. The analysis focused on comparing the length of hospital stay, recovery of gastrointestinal function, incidence of complications within 90 days post-surgery, postoperative extubation time (urinary tube and double-J tube), postoperative auxiliary examinations, and readmission rates within 30 days. Additionally, the patients were divided into two age groups: <4 years old and ≥4 years old, to assess pain severity.
Results:
There were no significant differences in preoperative general information, preoperative auxiliary examination findings, or intraoperative conditions between the ERAS and non-ERAS groups. The ERAS group had a significantly shorter postoperative hospital stay compared to the non-ERAS group. Furthermore, the time to the first postoperative bowel movement was shorter, and the incidence of postoperative complications was significantly lower in the ERAS group. Among children <4 years old, there was no significant difference in pain severity between the two groups. However, in children ≥4 years old, the ERAS group experienced significantly lower pain levels at 6 and 24 h post-surgery compared to the non-ERAS group.
Discussion:
The findings of this prospective randomized controlled trial should determine if ERAS is superior to traditional perioperative management in children undergoing RALP, particularly regarding postoperative hospital stay, intestinal function recovery, pain response, and complication rates. We anticipate that our data will offer valuable clinical insights and guidance for the implementation of ERAS in pediatric robotic surgery for urinary diseases.
Conclusion:
The ERAS protocol can reduce the length of hospital stay, aid in the recovery of gastrointestinal function, and lower postoperative complication rates. It also has the potential to lessen postoperative pain to varying degrees in certain pediatric patients. ERAS is a safe and effective protocol for pediatric patients undergoing RALP.
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