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Decreasing Length of Stay for Pectus Excavatum Repair by Implementing an ERAS Protocol
Taylor H Jacobs1, Erica Arnold1, Cindy McManaway1
1Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205.
Journal of Pediatric Surgery
|August 12, 2026
Summary
Enhanced recovery after surgery (ERAS) protocols significantly reduced length of stay and opioid use in pectus excavatum repair. This approach improved patient outcomes without increasing complications or readmissions.
Area of Science:
- Thoracic Surgery
- Surgical Innovation
- Patient Recovery Protocols
Background:
- Enhanced Recovery After Surgery (ERAS) protocols optimize patient recovery and minimize surgical complications.
- Intercostal nerve cryoablation has improved pain management in minimally invasive pectus excavatum repair (Nuss procedure).
- This study implemented a focused ERAS pathway to further reduce length of stay (LOS) for Nuss procedures.
Purpose of the Study:
- To evaluate the impact of a standardized ERAS protocol on length of stay (LOS) and opioid consumption in patients undergoing Nuss procedure.
- To compare outcomes of the ERAS pathway against historical cohorts with and without cryoablation.
Main Methods:
- A multidisciplinary ERAS pathway was developed, incorporating patient education, pain management, intercostal nerve blocks with cryoablation, and post-operative physical therapy.
- All patients undergoing Nuss procedure were included, comparing outcomes to pre-cryoablation (2014-2020) and cryoablation-only (2018-2023) cohorts.
- Key metrics included operating time, opioid usage (MME/kg), LOS, 30-day complications, and readmissions.
Main Results:
- The ERAS group (33 patients) demonstrated significantly reduced operating time (1:35 hrs), zero opioid usage (0.000 MME/kg), and shorter LOS (1.17 days) compared to cryoablation-only (3.00 days) and pre-cryoablation (4.39 days) cohorts.
- ERAS implementation led to a substantial decrease in inpatient charges ($46,839.45) compared to previous cohorts.
- No bar migrations were observed, and only one readmission occurred in the ERAS group.
Conclusions:
- A standardized ERAS protocol significantly decreases LOS and opioid requirements for pectus excavatum repair.
- The ERAS pathway enhances recovery without compromising patient safety, as evidenced by low readmission and complication rates.
- This protocol represents a significant advancement in optimizing outcomes for the Nuss procedure.
