Heather L Short1, Kurt F Heiss1, Katelyn Burch1, Curtis Travers2, John Edney3, Claudia Venable3, Mehul V Raval4. 1. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. 2. Division of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. 3. Division of Pediatric Anesthesiology, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. 4. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: mehulvraval@emory.edu.
Abstract
PURPOSE: Enhanced recovery protocols (ERPs) have been shown to improve outcomes in adult surgical populations. Our purpose was to compare outcomes before and after implementation of an ERP in children undergoing elective colorectal surgery. METHODS: A pediatric-specific colorectal ERP was developed and implemented at a single center starting in January 2015. A retrospective review was performed including 43 patients in the pre-ERP period (2012-2014) and 36 patients in the post-ERP period (2015-2016). Outcomes of interest included number of ERP interventions received, length of stay (LOS), complications, and readmissions. RESULTS: The median number of ERP interventions received per patient increased from 5 to 11 from 2012 to 2016. The median LOS decreased from 5days to 3days in the post-ERP period (p=0.01). We observed a simultaneous decrease in median time to regular diet, mean dose of narcotics, and mean volume of intraoperative fluids (p<0.001). The complication rate (21% vs. 17%, p=0.85) and 30-day readmission rate (23% vs. 11%, p=0.63) were not significantly different in the pre- and post-ERP periods. CONCLUSIONS: Implementation of a pediatric-specific ERP in children undergoing colorectal surgery is feasible, safe and may lead to improved outcomes. Further experience may highlight other opportunities for increased compliance and improved care. LEVEL OF EVIDENCE: Treatment Study. Level III.
PURPOSE: Enhanced recovery protocols (ERPs) have been shown to improve outcomes in adult surgical populations. Our purpose was to compare outcomes before and after implementation of an ERP in children undergoing elective colorectal surgery. METHODS: A pediatric-specific colorectal ERP was developed and implemented at a single center starting in January 2015. A retrospective review was performed including 43 patients in the pre-ERP period (2012-2014) and 36 patients in the post-ERP period (2015-2016). Outcomes of interest included number of ERP interventions received, length of stay (LOS), complications, and readmissions. RESULTS: The median number of ERP interventions received per patient increased from 5 to 11 from 2012 to 2016. The median LOS decreased from 5days to 3days in the post-ERP period (p=0.01). We observed a simultaneous decrease in median time to regular diet, mean dose of narcotics, and mean volume of intraoperative fluids (p<0.001). The complication rate (21% vs. 17%, p=0.85) and 30-day readmission rate (23% vs. 11%, p=0.63) were not significantly different in the pre- and post-ERP periods. CONCLUSIONS: Implementation of a pediatric-specific ERP in children undergoing colorectal surgery is feasible, safe and may lead to improved outcomes. Further experience may highlight other opportunities for increased compliance and improved care. LEVEL OF EVIDENCE: Treatment Study. Level III.
Authors: Jonathan Vacek; Teaniese Davis; Benjamin T Many; Sharron Close; Sarah Blake; Yue-Yung Hu; Jane L Holl; Julie Johnson; Jennifer Strople; Mehul V Raval Journal: J Pediatr Surg Date: 2020-06-27 Impact factor: 2.545
Authors: Cory McLaughlin; Anthony I Squillaro; Shadassa Ourshaliman; Ashley Song; Ashwini Lakshmanan; Giovanni Cucchiaro; Matthew Hall; Rita V Burke; Lorraine I Kelley-Quon Journal: Clin Ther Date: 2019-08-10 Impact factor: 3.393
Authors: Katherine J Baxter; Jennifer Hafling; Jennifer Sterner; Adarsh U Patel; Helen Giannopoulos; Kurt F Heiss; Mehul V Raval Journal: Pediatr Surg Int Date: 2018-05-04 Impact factor: 1.827
Authors: Anthony I Squillaro; Shadassa Ourshalimian; Cory M McLaughlin; Ashwini Lakshmanan; Philippe Friedlich; Cynthia Gong; Ashley Song; Lorraine I Kelley-Quon Journal: J Surg Res Date: 2020-07-08 Impact factor: 2.192
Authors: Ira L Leeds; Mitchell R Ladd; Margaret H Sundel; Melissa L Fannon; Jessica A George; Emily F Boss; Eric B Jelin Journal: J Pediatr Surg Date: 2018-05-04 Impact factor: 2.545
Authors: Mandy Rickard; Michael Chua; Jin Kyu Kim; Daniel T Keefe; Karen Milford; Jessica H Hannick; Joana Dos Santos; Martin A Koyle; Armando J Lorenzo Journal: World J Urol Date: 2021-03-03 Impact factor: 4.226