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Thoracic epidural-based Enhanced Recovery After Surgery (ERAS) pathway for Nuss repair of pectus excavatum shortened length of stay and decreased rescue intravenous opiate use

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Abstract

Background

PCA- and block-based enhanced recovery after surgery (ERAS) pathways have been shown to decrease hospital length of stay (HLOS) and opiate use following Nuss Repair for Pectus Excavatum (NRPE). No thoracic epidural-based ERAS pathway has demonstrated similar benefits.

Methods

In this pre-post single-center study, data were retrospectively collected for patients ≤ 21 years undergoing NRPE from May 2015 to August 2019. Univariate and multivariate methods were used to evaluate whether implementation of a thoracic epidural-based ERAS in April 2017 was associated with HLOS, opiate use, or pain scores.

Results

There were 110 patients: 35 pre- and 75 post-ERAS. HLOS decreased from median 4.8 (1.1) to 3.3 (0.6) days with ERAS (p < 0.001). Use of rescue intravenous opiates decreased from 35.3% pre- to 9.3% with ERAS (p = 0.013). When adjusted for baseline characteristics, ERAS was associated with a 1.3 ± 0.2 day decrease in HLOS and 0.188 times the odds of rescue intravenous opiate use (p = 0.011).

Conclusions

Pain scores, ED visits, and readmissions did not change with ERAS (p > 0.05). Implementation of a thoracic epidural-based ERAS following NRPE was associated with decreased HLOS and need for any rescue intravenous opiates without a change in pain scores, ED visits, or readmission.

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Abbreviations

NRPE:

Nuss repair for pectus excavatum

PCA:

Patient-controlled analgesia with intravenous opiates

HLOS:

Hospital length of stay

ERAS:

Enhanced recover after surgery

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Funding

This research did not receive any specific grant from funding agencies in the public, commercia, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, GRB-425, Boston, MA, 02114, USA

    Shannon L. Cramm

  2. Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA

    Casey Luckhurst, Alexandra Galls, Nicole Pietrantonio, Daniel P. Doody, Daniel P. Ryan & Peter T. Masiakos

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  1. Shannon L. Cramm
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  2. Casey Luckhurst
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Correspondence to Shannon L. Cramm.

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Cramm, S.L., Luckhurst, C., Galls, A. et al. Thoracic epidural-based Enhanced Recovery After Surgery (ERAS) pathway for Nuss repair of pectus excavatum shortened length of stay and decreased rescue intravenous opiate use. Pediatr Surg Int 37, 1191–1199 (2021). https://doi.org/10.1007/s00383-021-04934-x

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