Implementation of an Enhanced Recovery Pathway for Pediatric Single Lobe Thyroidectomy
Related Experiment Video
Updated: Aug 1, 2026
Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Shachi Srivatsa1, Lauren Parrish2, Cindy McManaway2
1Center for Surgical Outcomes and Research, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Insights
This study shows that Enhanced Recovery Pathways (ERP) are feasible for pediatric thyroid surgery, enabling same-day discharge and effective pain management without opioids. High patient satisfaction was achieved, suggesting ERPs can be adapted for pediatric care.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Perioperative Medicine
Background:
- Enhanced Recovery Pathways (ERP) optimize perioperative care in adults but are less common in pediatric populations.
- Pediatric thyroid surgery lacks established ERP protocols, necessitating research into their feasibility and effectiveness.
Purpose of the Study:
- To determine the feasibility and effectiveness of a pediatric-specific Enhanced Recovery Pathway (ERP) for single-lobe thyroidectomy.
- To evaluate outcomes including pain, nausea, discharge time, and patient satisfaction.
Main Methods:
- A prospective study of 16 pediatric patients (8+ years) undergoing single-lobe thyroidectomy.
- Implementation of a standardized ERP including preoperative, intraoperative, and postoperative care.
- Outcome measures: pain, nausea, discharge time, satisfaction; data analyzed using descriptive statistics.
Main Results:
- High ERP adherence (100%) with a 93.8% same-day discharge rate.
- Effective pain management (68.8% opioid-free) and high patient satisfaction (5/5 mean score).
- No intraoperative or postoperative complications, and no readmissions were reported.
Conclusions:
- A pediatric ERP for single-lobe thyroidectomy is feasible and effective.
- This approach facilitates same-day discharge, opioid-sparing pain control, and high patient satisfaction.
- ERPs can be safely adapted for pediatric thyroid surgery, potentially improving perioperative care standards.
Introduction:
Enhanced Recovery Pathways (ERP) have gained popularity for optimizing perioperative care, improving patient outcomes, and reducing hospital stays. While extensively studied in adult populations, ERPs in pediatric patients, especially for thyroid surgeries, are uncommon. The aim of this study was to determine the feasibility and effectiveness of implementing an ERP designed for pediatric patients undergoing single-lobe thyroidectomy.
Methods:
This prospective study was conducted at Nationwide Children's Hospital from January 2023 to December 2024 and involved children 8 years of age or older undergoing single lobe thyroidectomy. Patients with significant comorbid conditions or undergoing total thyroidectomy were excluded. The ERP incorporated standardized preoperative, intraoperative, and postoperative care. Outcome measures were postoperative pain, incidence of postoperative nausea, time to discharge, and patient/parent satisfaction. Data were analyzed using descriptive statistics.
Results:
16 patients were included, predominantly female (81.3 %, n = 13), ranging in age from 8 to 17 years. The median surgical time was 63 min (Interquartile Range [IQR]: 56.5, 75). Following surgery, patients spent a median of 60 min (IQR: 43, 63.5) in the post-anesthesia care unit (PACU) and 217 min (IQR: 189, 260) in the transitional care unit (TCU) before discharge. Adherence to the ERP was high, with 100 % compliance to the order set. 81 % of patients experienced no nausea or vomiting in the PACU/TCU. A single patient required an extended stay due to postoperative nausea, for same-day discharge success rate of 93.8 %. Post-discharge, 93.8 % of patients reported no nausea, and pain was effectively managed without opioid use in 68.8 % of patients. There were no intraoperative or postoperative complications. No patients required readmission, and all reported high satisfaction with the care received on post-operative satisfaction survey (mean score = 5/5).
Discussion:
Implementation of a pediatric ERP for single-lobe thyroidectomy was successful in promoting same-day discharge, effective pain control without opioids, healthcare utilization management, high patient satisfaction. These findings suggest that ERPs can be safely and effectively adapted for select pediatric thyroid surgery, potentially setting a new standard for perioperative care in this population.
Level Of Evidence:
III.
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:26Kidney Transplant II: Surgical Procedure