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Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of
Sara A Mansfield1,2, Meera Kotagal3,4, Stephen J Hartman3,4
1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Insights
Implementing Enhanced Recovery After Surgery (ERAS) pathways significantly reduced complications and length of stay for children undergoing abdominal neuroblastoma resection. ERAS protocols offer considerable benefits for pediatric patients requiring complex cancer surgeries and rapid recovery.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Clinical Pathway Implementation
Background:
- Enhanced Recovery After Surgery (ERAS) pathways are multidisciplinary protocols designed to optimize patient recovery post-operatively.
- Abdominal neuroblastoma resection in children often involves complex procedures and necessitates efficient recovery strategies.
Purpose of the Study:
- To evaluate the feasibility and benefits of implementing an ERAS pathway for pediatric patients undergoing abdominal neuroblastoma resection.
- To compare outcomes of ERAS pathway implementation against a historical cohort.
Main Methods:
- A prospective cohort of 23 children undergoing abdominal neuroblastoma resection between 2020-2022 were enrolled in an ERAS protocol across three institutions.
- Outcomes were compared to a historical cohort of 24 patients (2014-2020).
- Statistical analysis included Fisher's exact and t-tests.
Main Results:
- ERAS patients experienced a significant decrease in nasogastric tube use (16.7% vs 91.7%) and post-operative complications (39.1% vs 96%).
- Average length of stay was reduced from 6.9 days in the historical cohort to 3.7 days with ERAS (p = 0.004).
- Opioid consumption decreased by 61% (0.21 vs 0.54 MME/kg/day, p = 0.047), and ERAS patients advanced diets and ambulation 3 days earlier.
Conclusions:
- ERAS pathways are feasible and associated with improved outcomes, including reduced length of stay and fewer complications, in pediatric abdominal neuroblastoma surgery.
- Pediatric patients with neuroblastoma can significantly benefit from ERAS protocols due to the intensive nature of their treatment and surgical procedures.
Background:
Enhanced recovery after surgery (ERAS) pathways are multidisciplinary strategies to return patients to their physiologic baseline as efficiently as possible. This study aims to evaluate the feasibility and benefits of an ERAS pathway in children undergoing resection of abdominal neuroblastoma.
Methods:
After IRB approval, all patients greater than 1 month old undergoing resection of an abdominal neuroblastoma at one of three children's hospitals between 2020 and 2022 were offered enrollment. A standardized ERAS protocol was utilized at all institutions. Data were prospectively recorded. We compared the prospective cohort to a historic cohort (2014-2020). Fisher's exact and t-tests were used, as appropriate.
Results:
The study included 23 patients in the ERAS group compared to 24 historic patients. Post-operative nasogastric tube use decreased from 91.7% pre-ERAS to 16.7% in the ERAS cohort. ERAS patients were advanced to regular diets and ambulated 3 days earlier than pre-ERAS. Post-operative opioid consumption decreased from 0.54 to 0.21 milligram morphine equivalents (MME) mg/kg/day (p = 0.047). All but one patient (23, 96%) in the pre-ERAS cohort experienced at least one post-operative complication, compared to only nine (39.1%) in the ERAS cohort (p < 0.001). Average length of stay was 3.7 days with ERAS compared to 6.9 days pre-ERAS (p = 0.004).
Discussion:
ERAS is associated with improvements in length of stay and a decrease in complications following resection of abdominal neuroblastoma. Children with neuroblastoma stand to benefit considerably from the benefits associated with the use of an ERAS protocol, given their intensive treatment, complex surgeries, and need for expeditious recovery.
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