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Implementation and outcomes of enhanced recovery protocols in pediatric surgery: a systematic review and meta-analysis

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Abstract

Background

This systematic review examines the feasibility and safety of implementing Enhanced recovery after Surgery (ERAS) protocols in children.

Study design

A systematic search of Medline, PubMed, and the Cochrane library for papers describing ERAS implementation in children between January 2000 and January 2021. The systematic review was performed according to the PRISMA statement. The meta-analysis was done using R Software (Ver 4.0.2). p value of < 0.05 was considered statistically significant.

Results

Sixteen studies, describing a total of 1723 patients, were included in the meta-analysis. An average of 15 (range 11–16) relevant components were implemented with an overall compliance close to 84%. The time to initiate feeds and reach full enteral nutrition was reduced in ERAS group with mean difference (MD) of − 21.20 h (95% CI − 22.80, − 19.59, p < 0.01), and − 2.20 days (95% CI − 2.72, − 1.71, p < 0.01), respectively. The use of opioids for postoperative analgesia was reduced with MD of -0.86 morphine equivalents mg/kg (95% CI − 1.40, − 0.32, p < 0.01). The length of hospital stay showed a significant reduction with MD of -2.54 days (95% CI − 2.94, − 2.13, p < 0.01). There was no difference in the complication and readmission rates between the groups.

Conclusion

ERP implementation in pediatric perioperative care is a viable option in a variety of surgical settings. There is clear evidence of a decrease in hospital stay duration with no increase in complication or readmission rates. The length of hospital stay reduced in inverse proportion to the number of ERAS elements implemented. Parental satisfaction is increased by initiating enteral feeding early, minimizing catheter and drain use, and reducing opioid use.

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Fig. 1

Adopted from: Moher et al. Journal of Clinical Epidemiology, 2009

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, 632002, India

    Arun Kumar Loganathan & Susan Jehangir

  2. Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India

    Anita Shirley Joselyn

  3. Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

    Malavika Babu

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  1. Arun Kumar Loganathan
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  2. Anita Shirley Joselyn
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  3. Malavika Babu
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  4. Susan Jehangir
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Contributions

AKL: study search, study selection, data extraction, data synthesis, data interpretation, manuscript writing and editing. ASJ: study selection, data interpretation, manuscript writing. MB: data interpretation and statistics. SJ: conceptualization, study search, study selection, data synthesis, data interpretation, manuscript writing and editing.

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Correspondence to Susan Jehangir.

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Loganathan, A.K., Joselyn, A.S., Babu, M. et al. Implementation and outcomes of enhanced recovery protocols in pediatric surgery: a systematic review and meta-analysis. Pediatr Surg Int 38, 157–168 (2022). https://doi.org/10.1007/s00383-021-05008-8

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