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The enhanced recovery after surgery protocol in paediatric surgery: The analysis of the protocol principles based on
Michal Jerzy Pasierbek1, Anna Modrzyk1, Wojciech Korlacki1
1Medical University of Silesia, Katowice, Poland.
Insights
Enhanced recovery after surgery (ERAS) protocols show promise in pediatric care. While awareness is growing, full implementation of ERAS in pediatric surgery departments in Poland is limited, with varied adoption of specific elements.
Area of Science:
- Pediatric Surgery
- Surgical Protocols
Background:
- Enhanced Recovery After Surgery (ERAS) protocols optimize adult surgical outcomes by managing metabolic stress.
- The application and benefits of ERAS in pediatric populations are less established, necessitating further investigation.
Purpose of the Study:
- To assess the familiarity and implementation status of ERAS protocols in Polish pediatric surgery departments.
- To identify barriers and facilitators for ERAS adoption in pediatric colorectal surgery.
Main Methods:
- A questionnaire survey was distributed to heads of pediatric colorectal surgery departments in Poland.
- Seven out of 19 invited centers responded, detailing their knowledge and use of ERAS principles and specific protocol items.
Main Results:
- Five centers were familiar with ERAS, and two reported using it. Implementation varied, with 6 to 18 of 23 items adopted.
- No center utilized a zero fluid balance strategy. Preoperative fasting was avoided by five centers, and early oral nutrition was used by three.
Conclusions:
- ERAS protocols are recognized globally, offering a framework for improving pediatric surgical care.
- Findings suggest a need for wider ERAS adoption and tailored implementation strategies in pediatric surgery to enhance patient recovery.
Introduction:
The enhanced recovery after surgery (ERAS) protocol is a complex set of measures that improves patient outcomes in the adult population. The main goal of the protocol is to sustain homeostasis by mitigating the metabolic stress induced by surgical procedures. Hence, the search for similar solutions in paediatric patients since the benefits in the paediatric population are less well known.
Material And Methods:
The principles of the ERAS protocol were presented. A questionnaire survey was prepared to assess the preparation for the implementation of ERAS in paediatric surgery departments. Heads of all 19 clinical centres from Poland providing colorectal surgery in children were invited to participate. Seven centres responded to the survey. The questionnaire included four general questions related to the familiarity with ERAS and specific questions about the implementation of the 23-item protocol.
Results:
Five centres confirmed familiarity with the principles of the protocol and two of them confirmed the use of ERAS. The lowest number of implemented procedures was six, while the highest number was 18 out of 23. No centre implemented the zero fluid balance strategy. However, as many as five of the seven centres avoided preoperative fasting, three centres avoided mechanical bowel preparation, and three respondents used early oral nutrition in the postoperative period.
Conclusions:
The ERAS protocol is commonly used and accepted worldwide. Other surgical teams may use the information contained in the manuscript to create or improve their ERAS protocol.
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