Development of an enhanced recovery protocol for children undergoing gastrointestinal surgery

Mehul V. Raval*, Kurt F. Heiss

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Purpose of review Enhanced recovery protocols (ERPs) have been adopted for a variety of adult surgical conditions and resulted in markedly improved outcomes, including decreased length of stays, complications, costs, and narcotic utilization. In this review, we describe the development and implementation of an ERP for children undergoing gastrointestinal surgery. Recent findings Existing ERP components from adult and pediatric surgical populations were reviewed and modified through an iterative process that included literature review, a national survey of practicing pediatric surgeons, and appropriateness assessment by a multidisciplinary expert panel. A single-center pilot implementing a gastrointestinal ERP demonstrated a steady increase in the number of ERP elements being employed over time with a simultaneous decrease in length of stays, decrease in median time to regular diet, decrease in median dose of intraoperative and postoperative narcotics, and decrease in median volume of intraoperative fluids. Balancing measures such as complication rates and 30-day readmission rates were stable or trended toward improved outcomes. Summary ERPs for children undergoing gastrointestinal surgery appear feasible, safe, and associated with improved outcomes. Further validation of these results and expansion to a wider breadth of children's surgical care will help to establish ERPs as a new standard of surgical care.

Original languageEnglish (US)
Pages (from-to)399-404
Number of pages6
JournalCurrent opinion in pediatrics
Volume30
Issue number3
DOIs
StatePublished - Jun 1 2018

Keywords

  • enhanced recovery protocols
  • pediatric surgery
  • quality improvement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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