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Enhanced Recovery After Surgery for Pediatric Abdominal Tumor Resections: A Prospective Multi-institution Study
Sara A Mansfield1, Meera Kotagal2, Stephen J Hartman2
1Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
Insights
Enhanced Recovery After Surgery (ERAS) protocols are feasible for pediatric abdominal tumor resections. ERAS significantly reduced complications, opioid use, and improved recovery times in children.
Area of Science:
- Pediatric Surgery
- Oncology
- Enhanced Recovery After Surgery Protocols
Background:
- Enhanced Recovery After Surgery (ERAS) protocols standardize perioperative care.
- This study is the first prospective, multi-institutional evaluation of ERAS in pediatric patients undergoing abdominal tumor resections.
Purpose of the Study:
- To evaluate the feasibility and impact of ERAS protocols in pediatric patients undergoing abdominal tumor resections.
Main Methods:
- A prospective cohort of pediatric patients (>1 month old) undergoing abdominal tumor resection were enrolled between 2020-2022.
- ERAS protocol was standardized across three institutions.
- Compared to a propensity-matched historical cohort (2014-2020) using 16 variables.
Main Results:
- ERAS cohort (95 patients) showed a trend towards shorter median length of stay (LOS) (4.3 days) compared to the historic cohort (5.3 days).
- Post-operative opioid consumption was significantly lower in the ERAS cohort (p=0.013).
- ERAS patients experienced significantly fewer complications (44.2% vs 86.3%, p<0.001), earlier diet advancement, and faster ambulation.
Conclusions:
- ERAS protocols are feasible and safe for pediatric patients undergoing abdominal tumor resections.
- Implementation of ERAS significantly reduced complications, opioid consumption, and accelerated recovery.
- ERAS protocols represent a valuable approach to optimizing care for pediatric surgical oncology patients.
Background:
Enhanced recovery after surgery (ERAS) protocols are multi-disciplinary approaches to standardize perioperative care. This is the first prospective, multi-institutional study to evaluate ERAS in pediatric patients undergoing abdominal tumor resections.
Methods:
All patients >1-month-old undergoing abdominal tumor resection at one of three children's hospitals between 2020 and 2022 were eligible. ERAS counseling was performed, and informed consent obtained. The ERAS protocol was standardized across institutions. We compared the prospective cohort to a propensity-matched historical cohort (2014-2020) from each institution utilizing 16 variables. Categorical variables were compared using McNemar's and/or Stuart-Maxwell testing. Continuous data was compared using logistic regression.
Results:
Ninety-five patients enrolled in the prospective cohort and were compared to 95 well-matched historic patients. Median LOS was 5.3 (4.1-7.2) days in the historic cohort, and 4.3 (3.3-6.2) days in the ERAS cohort (p = 0.053). Post-operative opioid consumption was lower in ERAS patients at 0.08 (0.03-0.16) MME mg/kg/day versus 0.23 (0.12-0.52) in historic patients (p = 0.013). ERAS patients received clear (POD#0, 0-0) and regular (POD#1, 1.0-1.0) diets two days sooner (both p < 0.001). ERAS patients ambulated two days sooner (1.0, 1.0-2.0 versus 3.0, 2.0-5.0). The number of patients who experienced any complication was significantly lower in the ERAS cohort (44, 44.2 %) compared to historic (82, 86.3 %, p < 0.001). This reduction was seen across each Clavien-Dindo grade 1-3 category (all p < 0.05).
Conclusion:
ERAS protocols are feasible in pediatric patients undergoing abdominal tumor resections. Use of an ERAS protocol significantly reduced complications, opioid consumption, time to mobility, and time to diets.
Level Of Evidence:
II.
