Skip to main content

Pediatric Enhanced Recovery After Surgery

  • Chapter
  • First Online:
Enhanced Recovery After Surgery

Abstract

Surgical standardization and optimization in pediatrics is relatively new compared to well- described and well-established concepts of enhanced recovery after surgery (ERAS) in adult patients. However, evidence-based pediatric ERAS pathways that focus on optimizing all phases of surgical care can also provide value in pediatric surgical specialties by promoting multispecialty collaboration to improve the overall surgical experience of the child and the child’s family unit. Thoughtfully planned and carefully executed, pediatric ERAS protocols show great promise to hasten surgical recovery while reducing the surgical stress response, complication rates, and surgical costs for a variety of surgical procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606–17.

    Article  CAS  PubMed  Google Scholar 

  2. Reismann M, Dingemann J, Wolters M, Laupichler B, Suempelmann R, Ure BM. Fast-track concepts in routine pediatric surgery: a prospective study in 436 infants and children. Langenbeck’s Arch Surg. 2009;394:529–33.

    Article  Google Scholar 

  3. Reismann M, von Kampen M, Laupichler B, Suempelmann R, Schmidt AI, Ure BM. Fast-track surgery in infants and children. J Pediatr Surg. 2007;42:234–8.

    Article  PubMed  Google Scholar 

  4. Mattioli G, Palomba L, Avanzini S, Rapuzzi G, Guida E, Costanzo S, et al. Fast-track surgery of the colon in children. J Laparoendosc Adv Surg Tech A. 2009;19(Suppl 1):S7–9.

    Article  PubMed  Google Scholar 

  5. Schukfeh N, Reismann M, Ludwikowski B, Hofmann AD, Kaemmerer A, Metzelder ML, et al. Implementation of fast-track pediatric surgery in a German nonacademic institution without previous fast-track experience. Eur J Pediatr Surg. 2014;24:419–25.

    PubMed  Google Scholar 

  6. Vrecenak JD, Mattei P. Fast-track management is safe and effective after bowel resection in children with Crohn’s disease. J Pediatr Surg. 2014;49:99–102.

    Article  PubMed  Google Scholar 

  7. Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015;136(5):e1169–77.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Garren BR, Lawrence MB, McNaull PP, Sutherland R, Bukowski TP, Nielsen ME, Woody N, Clark McCall MHA, Ricketts K, Chidgey BA, Ross SS. Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients. J Pediatr Urol. 2019;15(3):260.e1–7.

    Article  CAS  Google Scholar 

  9. Chung CP, Callahan ST, Cooper WO, Dupont WD, Murray KT, Franklin AD, Hall K, Dudley JA, Stein CM, Ray WA. Outpatient opioid prescriptions for children and opioid-related adverse events. Pediatrics. 2018;142(2):e20172156.

    Article  PubMed  Google Scholar 

  10. Walker BJ, Long JB, Sathyamoorthy M, Birstler J, Wolf C, Bosenberg AT, Flack SH, Krane EJ, Sethna NF, Suresh S, Taenzer AH, Polaner DM, Pediatric Regional Anesthesia Network Investigators. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology. 2018;129(4):721–32.

    Article  PubMed  Google Scholar 

  11. Taenzer AH, Walker BJ, Bosenberg AT, Martin L, Suresh S, Polaner DM, Wolf C, Krane EJ. Asleep versus awake: does it matter?: Pediatric regional block complications by patient state: a report from the Pediatric Regional Anesthesia Network. Reg Anesth Pain Med. 2014;39(4):279–83.

    Article  PubMed  Google Scholar 

  12. Edney JC, Lam H, Raval MV, Heiss KF, Austin TM. Implementation of an enhanced recovery program in pediatric laparoscopic colorectal patients does not worsen analgesia despite reduced perioperative opioids: a retrospective, matched, non-inferiority study. Reg Anesth Pain Med. 2019;44(1):123–9.

    Article  PubMed  Google Scholar 

  13. Holmes DM, Polites SF, Roskos PL, Moir CR. Opioid use and length of stay following minimally invasive pectus excavatum repair in 436 patients – benefits of an enhanced recovery pathway. J Pediatr Surg. 2019;S0022–3468(19):30118–6.

    Google Scholar 

  14. Rove KO, Brockel MA, Saltzman AF, Dönmez MI, Brodie KE, Chalmers DJ, Caldwell BT, Vemulakonda VM, Wilcox DT. Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations. J Pediatr Urol. 2018;14(3):252.e1.

    Article  CAS  Google Scholar 

  15. Gable A, Burrier C, Stevens J, Wrona S, Klingele K, Bhalla T, Martin DP, Veneziano G, Tobias JD. Home peripheral nerve catheters: the first 24 months of experience at a children’s hospital. J Pain Res. 2016;9:1067–72.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Antony S, Gurnaney H, Ganesh A. Pediatric ambulatory continuous peripheral nerve blocks. Anesthesiol Clin. 2018;36(3):455–65.

    Article  PubMed  Google Scholar 

  17. Shinnick JK, Short HL, Heiss KF, Santore MT, Blakely ML, Raval MV. Enhancing recovery in pediatric surgery: a review of the literature. J Surg Res. 2016;202:165–76.

    Article  PubMed  Google Scholar 

  18. Short HL, Taylor N, Thakore M, Piper K, Baxter K, Heiss KF, et al. A survey of pediatric surgeons’ practices with enhanced recovery after children’s surgery. J Pediatr Surg. 2018;53(3):418–30.

    Article  PubMed  Google Scholar 

  19. Short HL, Taylor N, Piper K, Raval MV. Appropriateness of a pediatric-specific enhanced recovery protocol using a modified Delphi process and multidisciplinary expert panel. J Pediatr Surg. 2018;53(4):592–8.

    Article  PubMed  Google Scholar 

  20. Short HL, Heiss KF, Burch K, Travers C, Edney J, Venable C, et al. Implementation of an enhanced recovery protocol in pediatric colorectal surgery. J Pediatr Surg. 2018;53:688–92.

    Article  PubMed  Google Scholar 

  21. Baxter KJ, Short HL, Wetzel M, Steinberg RS, Heiss KF, Raval MV. Decreased opioid prescribing in children using an enhanced recovery protocol. J Pediatr Surg. 2019;54(6):1104–7.

    Article  PubMed  Google Scholar 

  22. Rove KO, Brockel MA, Brindle ME, Scott MJ, Herndon CDA, Ljungqvist O, et al. Embracing change-the time for pediatric enhanced recovery after surgery is now. J Pediatr Urol. 2019;S1477–5131(19):30080–4. (Epub ahead of print).

    Google Scholar 

  23. Bowlin P, Siparsky G, Wilcox D. Nationwide review of bladder augmentation in pediatric hospitals. J Urol. 2011;185:e477.

    Article  Google Scholar 

  24. McNamara ER, Kurtz MP, Schaeffer AJ, Logvinenko T, Nelson CP. 30-day morbidity after augmentation enterocystoplasty and appendicovesicostomy: a NSQIP pediatric analysis. J Pediatr Urol. 2015;11:209.e1–6.

    Article  Google Scholar 

  25. Segal I, Kang C, Albersheim SG, Skarsgard ED, Lavoie PM. Surgical site infections in infants admitted to the neonatal intensive care unit. J Pediatr Surg. 2014;49:381–4.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lee SK, McMillan DD, Ohlsson A, Pendray M, Synnes A, Whyte R, et al. Variations in practice and outcomes in the Canadian NICU network: 1996–1997. Pediatrics. 2000 Nov;106(5):1070–9.

    Article  CAS  PubMed  Google Scholar 

  27. Street JL, Montgomery D, Alder SC, Lambert DK, Gerstmann DR, Christensen RD. Implementing feeding guidelines for NICU patients <2000 g results in less variability in nutrition outcomes. JPEN J Parenter Enteral Nutr. 2006;30(6):515–8.

    Article  PubMed  Google Scholar 

  28. Tracy ET, Mears SE, Smith PB, Danko ME, Diesen DL, Fisher KA, et al. Protocolized approach to the management of congenital diaphragmatic hernia: benefits of reducing variability in care. J Pediatr Surg. 2010;45(6):1343–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gibb ACN, Crosby MA, McDiarmid C, Urban D, Lam JYK, Wales PW, et al. Creation of an Enhanced Recovery After Surgery (ERAS) guideline for neonatal intestinal surgery patients: a knowledge synthesis and consensus generation approach and protocol study. BMJ Open. 2018;8(12):e023651.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Okada Y, Klein N, van Saene HK, Pierro A. Small volumes of enteral feedings normalise immune function in infants receiving parenteral nutrition. J Pediat Surg. 1998;33:16–9.

    Article  CAS  PubMed  Google Scholar 

  31. Prasad GR, Rao JVS, Aziz A, Rashmi TM. Early enteral nutrition in neonates following abdominal surgery. J Neonatal Surg. 2018;7:21.

    Article  Google Scholar 

  32. Suresh S, Long J, Birmingham PK, De Oliveira GS Jr. Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database. Anesth Analg. 2015;120(1):151–6.

    Article  PubMed  Google Scholar 

  33. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016;7:CD001069.

    PubMed  Google Scholar 

  34. Larsson C, Wågström U, Normann E, Thernström Blomqvist Y. Parents experiences of discharge readiness from a Swedish neonatal intensive care unit. Nurs Open. 2016;4(2):90–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Franck LS, McNulty A, Alderdice F. The perinatal-neonatal care journey for parents of preterm infants. J Perinat Neonatal Nurs. 2017;31(3):244–55.

    Article  PubMed  Google Scholar 

  36. Franck LS, Oulton K, Nderitu S, Lim M, Fang S, Kaiser A. Parent involvement in pain management for NICU infants: a randomized controlled trial. Pediatrics. 2011;128(3):510–8.

    PubMed  Google Scholar 

  37. Ingram JC, Powell JE, Blair PS, Pontin D, Redshaw M, Manns S, et al. Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England. BMJ Open. 2016;6(3):e010752.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Pfander S, Bradley-Johnson S. Effects of an intervention program and its components on NICU infants. Child Health Care. 1990;19(3):140–6.

    Article  CAS  PubMed  Google Scholar 

  39. Martin CT, Pugely AJ, Gao Y, Mendoza-Lattes SA, Ilgenfritz RM, Callaghan JJ, et al. Increasing hospital charges for adolescent idiopathic scoliosis in the United States. Spine (Phila Pa 1976). 2014;39(20):1676–82.

    Article  Google Scholar 

  40. Fletcher ND, Andras LM, Lazarus DE, Owen RJ, Geddes BJ, Cao J, et al. Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop. 2017;37(2):92–7.

    Article  PubMed  Google Scholar 

  41. Muhly WT, Sankar WN, Ryan K, Norton A, Maxwell LG, DiMaggio T, et al. Rapid recovery pathway after spinal fusion for idiopathic scoliosis. Pediatrics. 2016;137(4):e20151568.

    Article  PubMed  Google Scholar 

  42. Kim E, Lee B, Cucchiaro G. Perioperative surgical home: evaluation of a new protocol focused on a multidisciplinary approach to manage children undergoing posterior spinal fusion operation. Anesth Analg. 2017;125(3):812–9.

    Article  PubMed  Google Scholar 

  43. Thomson K, Pestieau SR, Patel JJ, Gordish-Dressman H, Mirzada A, Kain ZN, et al. Perioperative surgical home in pediatric settings: preliminary results. Anesth Analg. 2016;123(5):1193–200.

    Article  PubMed  Google Scholar 

  44. Fletcher ND, Marks MC, Asghar JK, Hwang SW, Sponseller PD, Harms Study Group, Newton PO. Development of consensus based best practice guidelines for perioperative management of blood loss in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform. 2018;6(4):424–9.

    Article  PubMed  Google Scholar 

  45. Fletcher ND, Glotzbecker MP, Marks M, Newton PO, Harms Study Group. Development of consensus-based best practice guidelines for postoperative care following posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2017;42(9):E547–54.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew D. Franklin .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Franklin, A.D. et al. (2020). Pediatric Enhanced Recovery After Surgery. In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_58

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-33443-7_58

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-33442-0

  • Online ISBN: 978-3-030-33443-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics