A Modified Enhanced Recovery After Surgery Protocol Versus Standard Care in Pediatric Major Gastrointestinal Surgery:...

Area of Science:

• Pediatric Surgery
• Enhanced Recovery After Surgery (ERAS) Protocols
• Perioperative Care

Background:

• Pediatric major gastrointestinal surgery often involves prolonged fasting and delayed mobilization, increasing stress and slowing recovery.
• Enhanced Recovery After Surgery (ERAS) pathways, successful in adults, need adaptation for pediatric populations.
• Current standard care may not optimize perioperative management for young surgical patients.

Purpose of the Study:

• To evaluate a modified ERAS protocol against standard care in pediatric patients undergoing major gastrointestinal surgery.
• To assess the impact of the modified ERAS protocol on key recovery metrics.
• To determine if pediatric-adapted ERAS pathways improve perioperative outcomes.

Main Methods:

• Single-blind randomized controlled trial involving pediatric patients (2 months to 5 years) undergoing major gastrointestinal surgery.
• Randomization into two groups: modified ERAS protocol (n=40) and standard care (n=42).
• Outcomes measured: time to oral nutrition, mobilization, urinary catheter removal, length of hospital stay, and intraoperative glucose/electrolyte levels.

Main Results:

• The modified ERAS group showed significantly faster mobilization (p=0.014) and shorter hospital stays (p=0.018).
• Improved intraoperative glucose stability was observed in the modified ERAS group at later timepoints (p=0.047, p=0.008).
• No significant differences were found in time to oral nutrition or urinary catheter removal between groups.

Conclusions:

• A modified ERAS protocol enhances perioperative recovery in pediatric major gastrointestinal surgery.
• The protocol is associated with earlier mobilization, reduced hospitalization duration, and better glucose control.
• Adapting ERAS pathways for pediatric patients shows promise for improving surgical outcomes.