Preparing enhanced recovery after surgery for implementation in pediatric populations

Ira L Leeds; Emily F Boss; Jessica A George; Valerie Strockbine; Elizabeth C Wick; Eric B Jelin

doi:10.1016/j.jpedsurg.2016.08.029

Preparing enhanced recovery after surgery for implementation in pediatric populations

J Pediatr Surg. 2016 Dec;51(12):2126-2129. doi: 10.1016/j.jpedsurg.2016.08.029. Epub 2016 Sep 5.

Authors

Ira L Leeds¹, Emily F Boss², Jessica A George³, Valerie Strockbine⁴, Elizabeth C Wick¹, Eric B Jelin⁵

Affiliations

¹ Department of Surgery, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287.
² Department of Otolaryngology-Head and Neck Surgery and Health Policy & Management, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287.
³ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Children's Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287.
⁴ Department of Surgery, Johns Hopkins Bloomberg Children's Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg 7323, Baltimore, MD 21287.
⁵ Department of Surgery, Johns Hopkins Bloomberg Children's Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg 7323, Baltimore, MD 21287. Electronic address: ejelin1@jhmi.edu.

Abstract

Standardization in perioperative care has led to major improvements in surgical outcomes during the last two decades. Enhanced recovery after surgery (ERAS) programs are one example of a clinical pathway impacting both surgical outcomes and efficiency of care, but these programs have not yet been widely adapted for surgery in children. In adults, ERAS pathways have been shown to reduce length of stay, reduce complication rates, and improve patient satisfaction. These pathways improve outcomes through standardization of existing evidence-based best practices. Currently, the direct evidence for adapting ERAS pathways to pediatric surgery patients is limited. Challenges for implementation of ERAS programs for children include lack of direct translatability of adult evidence as well as varying levels acceptability of ERAS principles among pediatric providers and patients' families. We describe our newly implemented ERAS program for pediatric colorectal surgery patients in an era of limited direct evidence and discuss what further issues need to be addressed for broader implementation of pediatric ERAS pathways.

Level of evidence: Level 5.

Keywords: Enhanced recovery after surgery; Eras; Implementation; Pediatric; Surgery.

Publication types

Letter

MeSH terms

Child
Critical Pathways / organization & administration*
Digestive System Surgical Procedures / methods*
Humans
Perioperative Care / standards*

Abstract

Publication types

MeSH terms

Grants and funding