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Sustained Outcomes After Enhanced Recovery Pathway Implementation in Pediatric Colorectal Surgery
William Yu Luo1, Chis Agala2, Priya Vasan2
1The University of North Carolina at Chapel Hill School of Medicine, Department of Surgery, Chapel Hill, NC, USA; WakeMed Health and Hospitals, Raleigh, NC, USA.
Insights
Enhanced Recovery After Surgery Pathways (ERPs) significantly improved pediatric colorectal surgery outcomes, reducing length of stay and opioid use. Long-term analysis showed sustained benefits, highlighting ERPs
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Enhanced Recovery After Surgery
Background:
- Previous studies show Enhanced Recovery After Surgery Pathways (ERPs) improve outcomes in pediatric colorectal surgery.
- Long-term effects of specific ERP components on postoperative outcomes remain understudied.
Purpose of the Study:
- To evaluate the long-term impact of ERP implementation on pediatric colorectal surgery outcomes.
- To assess the sustained effects of ERPs during different implementation phases.
Main Methods:
- Retrospective, longitudinal cohort study of pediatric patients undergoing colorectal surgery.
- Poisson regression analysis to compare outcomes before and after ERP implementation.
- Secondary analysis comparing implementation and sustainment periods.
Main Results:
- ERPs significantly reduced length of stay (LOS) and opioid utilization (OU).
- ERPs led to shorter urinary catheter duration, reduced intravenous fluid (IVF) use, and faster return to oral intake.
- Outcomes further improved during the ERP sustainment phase.
Conclusions:
- This study represents the largest single-institution analysis of ERPs in pediatric colorectal surgery.
- ERPs significantly improve LOS, OU, catheter use, oral intake, and IVF management.
- Sustained ERP implementation is crucial for optimizing long-term pediatric surgical outcomes.
Introduction:
Previous studies have demonstrated improvements in length of stay and opioid utilization after implementing Enhanced Recovery After Surgery Pathways (ERPs) for pediatric colorectal surgery. However, the long-term impact of ERPs on postoperative outcomes following the implementation of specific ERP components has not been examined.
Methods:
In this single-institution retrospective and longitudinal cohort review of pediatric patients undergoing colorectal surgery before (Pre-ERP - 4/2014-8/2015) and after an ERP implementation (ERP - 9/2015-1/2024). Poisson regression was performed to determine the role of pathway implementation on length of stay (LOS), opioid utilization total (OU) (morphine milliequivalents/kilogram), indwelling urinary catheter use, total intravenous fluid (IVF) use, and time to PO intake. Secondary analysis compared patients during implementation (9/2015-4/2020) and sustainment periods (5/2020-1/2024) to report long-term ERP impacts.
Results:
On multivariable regression, LOS for ERP patients was lower than for pre-ERP patients, and OU was almost half the pre-ERP OU (p ≤ 0.01). The ERP cohort also had shorter indwelling urinary catheter duration, less IVF volume, and shorter time to PO intake. Secondary analysis found that these effects improved further in the post-ERP sustainment phase.
Conclusion:
To our knowledge, this represents the largest single-institution study to date of children ≤18 years old who underwent colorectal surgery before and after ERP implementation. There were significant improvements in LOS, OU, urinary catheter duration, time to PO intake, and IVF use. This is the first study to report the impact of ERPs after implementation during sustainment and emphasizes the importance of ERPs in optimizing pediatric surgical outcomes for children undergoing colorectal surgery.
Type Of Study:
Retrospective cohort study.
Level Of Evidence:
Level III.
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