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Enhancing recovery after minimally invasive repair of pectus excavatum

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Abstract

Purpose

There are variations in the perioperative management of patients who undergo minimally invasive repair of pectus excavatum (MIRPE). The purpose is to analyze the change in resource utilization after implementation of a standardized practice plan and describe an enhanced recovery pathway.

Methods

A standardized practice plan was implemented in 2013. A retrospective review of patients who underwent MIRPE from 2012 to 2015 was performed to evaluate the trends in resource utilization. A pain management protocol was implemented and a retrospective review was performed of patients who underwent repair before (2010–2012) and after (2014–2015) implementation.

Results

There were 71 patients included in the review of resource utilization. After implementation, there was a decrease in intensive care unit length of stay (LOS), and laboratory and radiologic studies ordered. There were 64 patients included in the pain protocol analysis. After implementation, postoperative morphine equivalents (3.3 ± 1.4 vs 1.2 ± 0.5 mg/kg, p < 0.01), urinary retention requiring catheterization (33 vs 14%, p = 0.07), and LOS (4 ± 1 vs 2.8 ± 0.8 days, p < 0.01) decreased.

Conclusion

The implementation of an enhanced recovery pathway is a feasible and effective way to reduce resource utilization and improve outcomes in pediatric patients who undergo minimally invasive repair of pectus excavatum.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Outpatient Care Center, Johns Hopkins All Children’s Hospital, 601 5th Street South, Dept 70-6600, 3rd Floor, St. Petersburg, FL, 33701, USA

    Cristen N. Litz, Sandra M. Farach, Nebbie E. Walford, Paul D. Danielson & Nicole M. Chandler

  2. Division of Anesthesia, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Allison M. Fernandez, Richard Elliott, Jenny Dolan & Will Nelson

  3. Division of Cardiothoracic Surgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Christopher Snyder & Jeffrey P. Jacobs

  4. Clinical and Translational Research Organization, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Ernest K. Amankwah

Authors
  1. Cristen N. Litz
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  2. Sandra M. Farach
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  3. Allison M. Fernandez
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  4. Richard Elliott
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  5. Jenny Dolan
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  8. Christopher Snyder
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Corresponding author

Correspondence to Cristen N. Litz.

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The authors declare that they have no competing interests.

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Litz, C.N., Farach, S.M., Fernandez, A.M. et al. Enhancing recovery after minimally invasive repair of pectus excavatum. Pediatr Surg Int 33, 1123–1129 (2017). https://doi.org/10.1007/s00383-017-4148-6

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  • DOI: https://doi.org/10.1007/s00383-017-4148-6

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