Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding

J Pediatr Surg. 2020 Jan;55(1):101-105. doi: 10.1016/j.jpedsurg.2019.09.065. Epub 2019 Nov 15.

Abstract

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: 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: 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: 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: Retrospective comparative study.

Level of evidence: Level III.

Keywords: Enhanced recovery after surgery; Inflammatory bowel disease; Pediatric surgery.

Publication types

  • Comparative Study

MeSH terms

  • 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

Substances

  • Analgesics, Opioid