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Pilot enhanced recovery after surgery protocol: Cranial vault remodeling for craniosynostosis
Melissa Janssen1, Jessica Sawaya2, Tanya Minasian1
1Department of Neurosurgery, Division of Pediatric Neurosurgery, Loma Linda University Children's Hospital, Loma Linda, California, United States.
Insights
This study introduces a pilot Enhanced Recovery After Surgery (ERAS) protocol for pediatric open cranial vault remodeling (CVR). The protocol aims to reduce patient stress and improve outcomes, with results comparable to national averages.
Area of Science:
- Pediatric surgery
- Surgical innovation
- Patient recovery protocols
Background:
- Enhanced Recovery After Surgery (ERAS) protocols standardize care to reduce hospital stay and improve patient experience.
- No existing ERAS protocol is available for pediatric open cranial vault remodeling (CVR).
- CVR is a complex procedure with a multidisciplinary treatment course, making it suitable for an ERAS protocol, especially in diverse populations with healthcare access barriers.
Purpose of the Study:
- To introduce a pilot ERAS protocol for pediatric open CVR at Loma Linda University Children's Hospital (LLUCH).
- To minimize psychological and physiological stress during the preoperative, intraoperative, and postoperative phases of CVR.
- To address healthcare accessibility challenges in San Bernardino County by optimizing open CVR procedures.
Main Methods:
- Implementation of a pilot ERAS protocol at LLUCH since 2018.
- Standardized preoperative checklists for cleansing, fasting, and laboratory criteria.
- Intraoperative guidelines for antibiotics, fluid management, pain control, and medication administration (tranexamic acid, mannitol).
- Standardized postoperative criteria for intensive care unit progression and discharge.
Main Results:
- The CVR process at LLUCH begins with interdisciplinary review and engagement.
- Day-of-surgery checklists ensure standardized preoperative preparation.
- Intraoperative protocols promote transparency and standardized management of key parameters.
- Postoperative criteria guide patient care from ICU to discharge.
Conclusions:
- A retrospective chart review will compare LLUCH outcomes with the National Surgical Quality Improvement Program.
- The study aims to demonstrate that the LLUCH CVR process is comparable to national benchmarks.
- Successful implementation of the standardized ERAS protocol is expected to significantly improve clinical and social outcomes for pediatric CVR patients.
Background:
Enhanced recovery after surgery (ERAS) protocols are standardized procedural guidelines proven to decrease hospital stay and postoperative narcotic use and improve overall patient experience. There is no existing ERAS protocol for open cranial vault remodeling (CVR) in the pediatric population. We believe that CVR is one such surgery meriting an ERAS protocol given its multidisciplinary and longitudinal treatment course. Such protocol is of particular interest in San Bernardino County, where the vast geographic area and wide socioeconomic spectrum result in unique barriers to healthcare accessibility that favor open remodeling over endoscopic approaches.
Methods:
The primary purpose of an ERAS protocol is to minimize both psychological and physiologic stress associated with a given procedure. This can be targeted at various phases of the patient encounter, including the preoperative, intraoperative, and postoperative stages. Here, we introduce our pilot protocol for ERAS implemented at Loma Linda University Children's Hospital (LLUCH) starting since 2018.
Results:
Our CVR process begins at the craniofacial clinic, where interdisciplinary chart and imaging review ensure appropriate patient enrollment and clinical service engagement. Day of surgery checklists ensure standardized preoperative cleansing, fasting, and laboratory criteria. Intraoperative guidelines facilitate interdisciplinary transparency regarding antibiotics, blood transfusions, fluid status, pain control, and tranexamic acid and mannitol administration. Standardized postoperative criteria dictate progression through the intensive care unit through to discharge.
Conclusion:
Retrospective chart review will compare LLUCH outcomes to those reflected in the National Surgical Quality Improvement Program. We hope to demonstrate that the CVR process at LLUCH is comparable to the national average and that implementation of a standardized ERAS protocol can significantly improve clinical and social outcomes.
