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Retrospective review of baseline practices prior to implementing an enhanced recovery programme
Lydia Iris Healy1, Sophie Duignan2, Cormac V Breatnach1,3
1Paediatric Intensive Care, Children's Health Ireland at Crumlinhttps://ror.org/025qedy81, Ireland.
Insights
This study assessed pediatric cardiac surgery recovery in Europe, finding early extubation and hospital stays comparable to enhanced recovery programs. Further improvements are possible by tailoring programs to specific hospital contexts.
Area of Science:
- Pediatric Cardiac Surgery
- Enhanced Recovery Programs
- Peri-operative Care
Background:
- Enhanced recovery after surgery (ERAS) has proven benefits in pediatric cardiac surgery.
- Formal ERAS programs are underutilized in European centers.
- Assessing current performance is crucial before implementing ERAS.
Purpose of the Study:
- To evaluate the peri-operative course of low-risk children undergoing congenital cardiac surgery.
- To identify areas for improvement in current post-operative care pathways.
- To benchmark current practices against established ERAS outcomes.
Main Methods:
- Retrospective single-center cohort study.
- Inclusion of 73 low-risk pediatric patients undergoing congenital cardiac surgery.
- Data extraction from electronic and paper records on respiratory/hemodynamic support, devices, length of stay, and analgesia.
Main Results:
- 71% of patients had early extubation (within 6 hours).
- Most invasive devices were removed on the ward.
- Median intensive care unit (ICU) length of stay was 1.1 days; total hospital stay was 4.3 days.
Conclusions:
- Early extubation and length of stay align with some established ERAS programs.
- Opportunities exist for further optimization of recovery pathways.
- Site-specific considerations are vital for successful ERAS implementation.
Background:
Enhanced recovery after surgery has an established evidence base in paediatric cardiac surgery, but formal programmes are infrequently implemented in Europe. Before implementing a programme, it is essential to assess current performance for benchmarking and to identify potential pitfalls.
Methods:
A retrospective single-centre cohort study was performed to assess the peri-operative course of a low-risk group of children undergoing congenital cardiac surgery. Patient data were collected for the entire post-operative course before discharge home or to a different centre. Data regarding respiratory and haemodynamic support, invasive devices, length of stay, and analgesia were extracted from electronic intensive care records and paper ward records.
Results:
The search criteria yielded 1042 operations. Following a detailed assessment of inclusion and exclusion criteria, 73 patients were included in the study. Included patients had a median age of 3.1 years and a median weight of 13 kg. Seventy-one per cent (52/73) of patients underwent early extubation within six hours. Some children without contraindications did not receive non-opioid analgesia. Most invasive devices (pacing wires, drains, and central venous catheters) were removed on the ward. The median length of stay was 1.1 days in critical care and 4.3 in hospital.
Conclusions:
Early extubation and duration of stay were comparable to outcomes published by some established enhanced recovery after surgery programmes, although shorter stays are achievable. Areas for improvement were identified. A centre's specific context must be considered when implementing aspects of an enhanced recovery after surgery programme.
