Implementation of an Enhanced Recovery Pathway for Pediatric Single Lobe Thyroidectomy

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.

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.

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).

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.

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