Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations

Summary Background Enhanced recovery after surgery (ERAS) protocol is a set of peri-operative strategies to increase speed of recovery. ERAS is well established in adults but has not been well studied in children. Objective The purpose of the current study was to establish the safety and efficacy of an ERAS protocol in pediatric urology patients undergoing reconstructive operations. It was hypothesized that ERAS would reduce length of stay and decrease complications when compared with historical controls. Study design Institutional Review Board approval was obtained to prospectively enroll patients aged Results A total of 26 historical and 13 ERAS patients were included. Median ages were 10.4 (IQR 8.0–12.4) and 9.9 years (IQR 9.1–11), respectively ( P  = 0.94) (see Summary Table ). There were no significant between-group differences in prior abdominal surgery (38% vs 62%), rate of augmentation (88% vs 92%) or primary diagnosis of spina bifida (both 62%). ERAS significantly improved use of pre-operative liquid load ( P P  = 0.046), early discontinuation of IVF ( P P P  = 0.520). Complications of any grade per patient decreased from 2.1 to 1.3 (OR 0.71, 95% CI 0.51–0.97). There were fewer complications per patient across all grades with ERAS. No differences were seen in emergency department (ED) visits, re-admissions and re-operations. Discussion Implementation improved consistency of care delivered. Tenets of ERAS that appeared to drive improvements included maintenance of euvolemia through avoidance of excess fluids, multimodal analgesia, and early feeding. Conclusion ERAS decreased length of stay and 90-day complications after pediatric reconstructive surgery without increased re-admissions, re-operations or ED visits. A multicenter study will be required to confirm the potential benefits of adopting ERAS. Summary Table . Pertinent findings regarding matched historical controls and patients who received care under an enhanced recovery after surgery protocol. Significant differences between groups with P Matched P -value Historical ERAS Total patients 26 patients 13 patients – Median age, years (IQR) 10.4 (8.0–12.4) 9.9 (9.1–11.0) 0.940 Patients with spina bifida 16 (62%) 8 (62%) 1.000 Median protocol items per patient (IQR) 8 (4–9) 12 (11–12) Median length of stay,# midnights (IQR) 6 (5–7) 5 (3–6) 0.520 Total complications within 90 days 56 (2.1/patient) 17 (1.3/patient) 0.035 Re-admissions within 30 days 7 (0.27/patient) 1 (0.08/patient) 0.265 Re-operations within 90 days 8 (0.31/patient) 1 (0.08/patient) 0.235 ED visits within 90 days 17 (0.65/patient) 7 (0.54/patient) 0.570 ERAS, Enhanced recovery after surgery; ED, emergency department.