Outcomes After Implementation of an Enhanced Recovery Protocol for Minimally Invasive Repair of Pectus Excavatum

Area of Science:

• Thoracic surgery
• Pediatric surgery
• Surgical outcomes research

Background:

• Pectus excavatum repair often involves severe post-operative pain, leading to extended hospital stays and intensive care.
• Current management necessitates significant sedative and analgesic infusions, increasing healthcare resource utilization.

Purpose of the Study:

• To evaluate the impact of an enhanced recovery after surgery (ERAS) protocol on patients undergoing minimally invasive pectus excavatum repair.
• To assess reductions in hospital length of stay, intensive care unit (ICU) utilization, and opioid consumption.

Main Methods:

• Retrospective chart review of patients under 25 years old who had Nuss bar insertion between January 2011 and May 2021.
• Comparison of outcomes before and after ERAS protocol implementation in December 2017.
• Primary outcomes: hospital length of stay, ICU utilization, and opioid consumption.

Main Results:

• ERAS cohort showed a significantly reduced mean hospital stay (1.9 vs. 4.9 days).
• No ERAS patients required ICU admission post-operatively, compared to an average of 3 days for non-ERAS patients.
• Narcotic patient-controlled analgesia (PCA) use decreased by nearly half, with significant reductions in total opioid dosages.

Conclusions:

• Enhanced recovery after surgery (ERAS) protocol implementation led to significant reductions in hospital stay, ICU use, and opioid consumption after Nuss repair.
• These improvements are expected to lower healthcare costs and facilitate earlier return to daily activities and school.