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Enhanced Recovery After Surgery for Pediatric Lung Resection: Effects of a New Protocol
Andrew J Behrmann1, Elizabeth A Shumway1, Brooklyn Campbell1
1Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.
Insights
Enhanced recovery after surgery (ERAS) protocols significantly reduce recovery times and complications in pediatric thoracoscopic lobectomies. This approach lowers healthcare costs and family disruption compared to traditional care.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Enhanced Recovery Protocols
Background:
- Prenatal diagnosis of congenital lung lesions is increasing due to advanced imaging techniques.
- Thoracoscopic lobectomy is a safe and effective treatment for these lesions.
- Standardized care pathways are needed to optimize outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) protocol for pediatric thoracoscopic lobectomy.
- To compare outcomes between patients managed with ERAS and a traditional non-ERAS approach.
Main Methods:
- A retrospective chart review of twenty patients (10 ERAS, 10 non-ERAS) who underwent thoracoscopic lobectomy between 2014 and 2024.
- Comparison of postoperative length of stay, chest tube duration, analgesic requirements, complications, and healthcare costs.
Main Results:
- ERAS patients had significantly shorter postoperative length of stay (1.77 vs. 5.25 days, p=0.03) and chest tube duration (1.44 vs. 3.64 days, p=0.01).
- ERAS group required less opioid analgesics (p=0.0046), experienced no reintubations or prolonged air leaks, and had zero complications compared to five in the non-ERAS group (p=0.02).
- The ERAS protocol reduced healthcare costs (p=0.0037) and associated family disruption.
Conclusions:
- The novel ERAS protocol is safe and effective for pediatric thoracoscopic lobectomies.
- ERAS implementation reduces postoperative recovery times, complications, and healthcare burden.
- This approach facilitates earlier discharge, improving resource utilization and minimizing disruption for families.
Abstract:
Background: Prenatal detection of congenital lung lesions has increased with improved imaging. These abnormalities are safely treated with thoracoscopic lobectomy. We implemented an enhanced recovery after surgery (ERAS) protocol to standardize care and aim to evaluate its safety and efficacy compared to a non-ERAS cohort. Methods: A single-center retrospective chart review was conducted for twenty patients (n = 10 ERAS, n = 10 non-ERAS) undergoing thoracoscopic lobectomy from 2014-2024. Results: ERAS patients were generally younger at the time of surgery (ERAS: 4.25 ± 2.76 months vs. non-ERAS: 6.45 ± 6.78 months, p = 0.17). Postoperative length of stay was shorter in ERAS (1.77 ± 0.60 days) vs. non-ERAS patients (5.25 ± 3.79 days, p = 0.03) as well as chest tube duration (ERAS: 1.44 ± 0.73 days vs. non-ERAS 3.64 ± 2.38 days, p = 0.01). ERAS patients received lower amounts of opioid analgesics compared to non-ERAS (p = 0.0046). Use of the ERAS protocol also decreased cost for the healthcare system compared to non-ERAS patients (p = 0.0037). ERAS patients had no reintubations or prolonged air leaks (defined as >48 h), compared to four reintubations (p = 0.04) and three prolonged air leaks (p = 0.07) in the non-ERAS group. Crucially, there were no complications in the ERAS group, whereas five non-ERAS patients experienced Clavien-Dindo level III (one IIIa, two IIIb, two IVa) complications (p = 0.02). Conclusions: Our preliminary findings demonstrate the successful integration of a novel ERAS protocol in pediatric thoracoscopic lobectomies and its efficacy in reducing standard post-operative recovery times without an increased rate of complications. Earlier discharge in the ERAS group constitutes less healthcare burden with improved resource utilization and less family, work, and social disruption.
