A survey of pediatric surgeons' practices with enhanced recovery after children's surgery

Purpose: Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve outcomes in adult abdominal surgical populations. Our purpose was to survey pediatric surgeons' opinions regarding applicability of individual ERAS elements to children's surgery. Methods: A survey of the American Pediatric Surgical Association was conducted electronically. Using a 5-point Likert scale, respondents rated their willingness to implement 21 adult ERAS elements in an adolescent undergoing elective colorectal surgery. Results: Of an estimated 1052 members, 257 completed the survey (24%). The majority of the respondents (n = 175, 68.4%) rated their familiarity with ERAS as “moderately”, “very”, or “extremely familiar”. However only 19.2% (n = 49) replied that they were “already implementing” an ERAS protocol in their practice. Most respondents replied that they were “already doing” or “definitely willing” to implement 14 of the 21 (67%) ERAS elements. For the remaining 7 elements, > 10% of surgeons answered that they were only “somewhat willing” to, “uncertain” about or “unwilling” to implement these interventions. Conclusions: Most respondents were willing to implement the majority of adult ERAS concepts in children undergoing abdominal surgery. However, we identified 7 elements that remain contentious. Further investigation regarding the safety and feasibility of these elements is warranted before applying them to children's surgery. Level of evidence: Level V.