Identifying Components of an Enhanced Recovery Pathway for Primary Cleft Palate Repair: A Scoping Review.

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Evidence-Based Medicine

Background:

• Enhanced Recovery Pathways (ERPs) are multimodal, patient-centered care strategies aimed at reducing surgical stress and improving outcomes.
• ERPs are increasingly being reported in the context of cleft lip and palate surgery.
• Evidence mapping is needed to guide the development of ERPs for primary cleft palate repair.

Purpose of the Study:

• To map existing evidence on perioperative care and recovery strategies for primary cleft palate repair.
• To identify essential components for an enhanced recovery pathway (ERP) for this procedure.
• To pinpoint gaps in current knowledge regarding perioperative care for cleft palate repair.

Main Methods:

• A scoping review was conducted using PubMed, Embase, Cochrane, and Scopus databases.
• Studies describing strategies or elements for enhanced recovery following primary cleft palate repair were included.
• Data on ERP elements and outcome measures were extracted and collated using Covidence software.

Main Results:

• Forty-seven studies were included in the review.
• Frequently reported elements included anesthesia, perioperative analgesia, and parent education.
• Key proposed ERP elements include preoperative education, minimized fasting, analgesia, nerve blocks, perioperative medications, early feeding, and discharge planning. Evidence on nursing care was limited.

Conclusions:

• The findings provide a framework for developing institutional ERPs for primary cleft palate repair.
• The role of consistent nursing care in enhanced recovery is significant but under-investigated.
• Further research is warranted to explore the impact of ERPs on parent-reported outcomes.