Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding.
Analgesics, Opioid
/ therapeutic use
Anesthesia, Conduction
Child
Clinical Protocols
Cohort Studies
Critical Pathways
Enteral Nutrition
Female
Humans
Inflammatory Bowel Diseases
/ surgery
Laparoscopy
/ standards
Length of Stay
Male
Minimally Invasive Surgical Procedures
Pain Management
Retrospective Studies
Enhanced recovery after surgery
Inflammatory bowel disease
Pediatric surgery
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
04
09
2019
accepted:
29
09
2019
pubmed:
1
12
2019
medline:
5
9
2020
entrez:
1
12
2019
Statut:
ppublish
Résumé
We hypothesized that an enhanced recovery after surgery (ERAS) pathway for pediatric patients undergoing surgery for inflammatory bowel disease (IBD) would be beneficial. This is a single institution retrospective comparative study comparing patients treated with an ERAS pathway to consecutive patients in a Preimplementation Cohort (PIC) with similar open and laparoscopic surgeries for IBD. The pathway emphasized minimal preoperative fasting, multimodal and regional analgesia, and early enteral nutrition after surgery. Primary endpoints were time to 120 mL of PO intake (POI), length of stay (LOS), opioid utilization, and 30-day surgical outcomes. Continuous and categorical variables were compared (p < 0.05). There were 23 PIC and 28 ERAS patients with similar demographic data and surgical and anesthetic approaches. ERAS patients experienced a significant increase in the use of regional anesthesia, faster time to POI, and a nonsignificant decrease in mean LOS. ERAS patients had decreased total and daily opioid use with similar complication rates. This study demonstrates the effectiveness of a pediatric ERAS pathway for IBD patients requiring laparoscopic and (unique to this study) open surgery. The study demonstrates that opioid utilization and time to feeding can be positively impacted using ERAS pathways without negatively impacting outcomes. Retrospective comparative study. Level III.
Sections du résumé
BACKGROUND
BACKGROUND
We hypothesized that an enhanced recovery after surgery (ERAS) pathway for pediatric patients undergoing surgery for inflammatory bowel disease (IBD) would be beneficial.
METHODS
METHODS
This is a single institution retrospective comparative study comparing patients treated with an ERAS pathway to consecutive patients in a Preimplementation Cohort (PIC) with similar open and laparoscopic surgeries for IBD. The pathway emphasized minimal preoperative fasting, multimodal and regional analgesia, and early enteral nutrition after surgery. Primary endpoints were time to 120 mL of PO intake (POI), length of stay (LOS), opioid utilization, and 30-day surgical outcomes. Continuous and categorical variables were compared (p < 0.05).
RESULTS
RESULTS
There were 23 PIC and 28 ERAS patients with similar demographic data and surgical and anesthetic approaches. ERAS patients experienced a significant increase in the use of regional anesthesia, faster time to POI, and a nonsignificant decrease in mean LOS. ERAS patients had decreased total and daily opioid use with similar complication rates.
CONCLUSION
CONCLUSIONS
This study demonstrates the effectiveness of a pediatric ERAS pathway for IBD patients requiring laparoscopic and (unique to this study) open surgery. The study demonstrates that opioid utilization and time to feeding can be positively impacted using ERAS pathways without negatively impacting outcomes.
TYPE OF STUDY
METHODS
Retrospective comparative study.
LEVEL OF EVIDENCE
METHODS
Level III.
Identifiants
pubmed: 31784102
pii: S0022-3468(19)30718-3
doi: 10.1016/j.jpedsurg.2019.09.065
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101-105Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.