Utilization of an Enhanced Recovery After Surgery (ERAS) protocol for pediatric metabolic and bariatric surgery
Copyright © 2022 Elsevier Inc. All rights reserved..
INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols for pediatric metabolic and bariatric surgery are limited. In 2018, an ERAS protocol for patients undergoing robotically assisted vertical sleeve gastrectomy (r-VSG) was instituted. This study's aim was to compare outcomes before and after ERAS initiation.
METHODS: A single institution retrospective review of patients undergoing r-VSG from July 2015 to July 2021 was performed. The multimodal ERAS protocol focused on limiting post-operative nausea and narcotic utilization. Subjects were categorized into non-ERAS (July 2015-July 2018) and ERAS (August 2018-July 2021) groups. In-hospital and 30-day outcomes were compared.
RESULTS: 110 subjects (94 females) with a median age of 17.6 years (range 12.5-22.0 years) were included (60 non-ERAS, 50 ERAS). Demographics were similar except for a higher proportion of females in the non-ERAS group (97% vs 72%, p < 0.001). A significant decrease in narcotic use (p < 0.001) and higher utilization of acetaminophen (p < 0.001) and ketorolac (p < 0.001) was observed in the ERAS group. Additionally, median time to oral intake, a proxy for postoperative nausea and vomiting [2:00 h (1:15, 2:30) vs. 3:22 h (2:03, 6:15), p < 0.001] and hospital length of stay (LOS) [1.25 days (1.14, 1.34) vs. 2.16 days (1.48, 2.42), p < 0.001] were shorter in the ERAS group. Eleven subjects (10%; ERAS = 5, non-ERAS = 6) experienced post-discharge dehydration, prompting readmission 8 times for 7 (6%) individuals.
CONCLUSION: Utilization of ERAS led to a significant decrease narcotic utilization, time to first oral intake, and hospital LOS with no change in adverse events following pediatric metabolic and bariatric surgery. Larger studies, including comparative analysis of health care utilization, should be carried out.
LEVEL OF EVIDENCE: III.
TYPE OF STUDY: Treatment Study.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:58 |
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| Enthalten in: |
Journal of pediatric surgery - 58(2023), 4 vom: 09. Apr., Seite 695-701 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Svetanoff, Wendy Jo [VerfasserIn] |
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| Links: |
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| Themen: |
Bariatric surgery |
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| Anmerkungen: |
Date Completed 20.03.2023 Date Revised 20.03.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jpedsurg.2022.12.014 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM351522204 |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Elsevier Inc. All rights reserved. | ||
| 520 | |a INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols for pediatric metabolic and bariatric surgery are limited. In 2018, an ERAS protocol for patients undergoing robotically assisted vertical sleeve gastrectomy (r-VSG) was instituted. This study's aim was to compare outcomes before and after ERAS initiation | ||
| 520 | |a METHODS: A single institution retrospective review of patients undergoing r-VSG from July 2015 to July 2021 was performed. The multimodal ERAS protocol focused on limiting post-operative nausea and narcotic utilization. Subjects were categorized into non-ERAS (July 2015-July 2018) and ERAS (August 2018-July 2021) groups. In-hospital and 30-day outcomes were compared | ||
| 520 | |a RESULTS: 110 subjects (94 females) with a median age of 17.6 years (range 12.5-22.0 years) were included (60 non-ERAS, 50 ERAS). Demographics were similar except for a higher proportion of females in the non-ERAS group (97% vs 72%, p < 0.001). A significant decrease in narcotic use (p < 0.001) and higher utilization of acetaminophen (p < 0.001) and ketorolac (p < 0.001) was observed in the ERAS group. Additionally, median time to oral intake, a proxy for postoperative nausea and vomiting [2:00 h (1:15, 2:30) vs. 3:22 h (2:03, 6:15), p < 0.001] and hospital length of stay (LOS) [1.25 days (1.14, 1.34) vs. 2.16 days (1.48, 2.42), p < 0.001] were shorter in the ERAS group. Eleven subjects (10%; ERAS = 5, non-ERAS = 6) experienced post-discharge dehydration, prompting readmission 8 times for 7 (6%) individuals | ||
| 520 | |a CONCLUSION: Utilization of ERAS led to a significant decrease narcotic utilization, time to first oral intake, and hospital LOS with no change in adverse events following pediatric metabolic and bariatric surgery. Larger studies, including comparative analysis of health care utilization, should be carried out | ||
| 520 | |a LEVEL OF EVIDENCE: III | ||
| 520 | |a TYPE OF STUDY: Treatment Study | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Bariatric surgery | |
| 650 | 4 | |a ERAS | |
| 650 | 4 | |a Enhanced recovery | |
| 650 | 4 | |a Pediatric surgery | |
| 650 | 4 | |a Vertical sleeve gastrectomy | |
| 650 | 7 | |a Narcotics |2 NLM | |
| 700 | 1 | |a Diefenbach, Karen |e verfasserin |4 aut | |
| 700 | 1 | |a Hall, Brian |e verfasserin |4 aut | |
| 700 | 1 | |a Craver, Amber |e verfasserin |4 aut | |
| 700 | 1 | |a Rutledge, Sarah |e verfasserin |4 aut | |
| 700 | 1 | |a McManaway, Cindy |e verfasserin |4 aut | |
| 700 | 1 | |a Eneli, Ihuoma |e verfasserin |4 aut | |
| 700 | 1 | |a Tobias, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Michalsky, Marc P |e verfasserin |4 aut | |
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