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Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic cholecystectomy surgery

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Abstract

Purpose

Enhanced recovery protocols [ERPs] standardize care and have been demonstrated to improve surgical quality in adults. We retrospectively compared outcomes before and after implementation of ERPs in children undergoing elective laparoscopic cholecystectomy [ELC] surgery.

Methods

A pediatric-specific ERP was implemented for children undergoing ELC at one [C1] of the two Pediatric Surgical Centers in July 2016. We retrospectively reviewed 606 patients undergoing ELC between July 2014 and December 2019. Of these, 206 patients underwent ELC prior to ERP implementation [Pre-ERP] were compared to 400 patients undergoing ELC managed in the post-ERP implementation period (between January 2017 and December 2019), 21 of which were managed by enhanced recovery protocol. Primary Outcomes included immediate peri-operative and post-operative narcotic use in mean morphine equivalents [MME], narcotics at discharge, complications, nurse calls and returns to system [RTS].

Results

There was a significant decrease in opioid use both post-operatively and at time of discharge in the ERP managed cohort. The MME use during the post-operative period was 0.85 in the in ERP-compliant patients compared to 6.40 in the non-compliant group (p < 0.027). Eighty-six percent of ERP-compliant patients in the study required no narcotics at discharge, which was statistically significant when compared to ERP non-compliant cohort (p < 0.0001). There was also no change in RTS, nurse calls or complications. In addition, in the post-ERP period (2017–2019), a dominant proportion of patients at C1 partially complied with the ERP, resulting in a statistically significantly decrease of opioid use between sites in the post-op period (6.54 vs 10.57 MME) post-ERP (p < 0.001). Similar effects were noted in discharge narcotics.

Conclusion

The use of pediatric-specific ERP in children undergoing ELC is safe, effective, and provides compassionate pain control while leading to a reduction in opioid use peri-operatively and at discharge. This improvement occurred without changes in RTS, nursing calls or complications.

Level of evidence

Level III; Retrospective study.

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Abbreviations

ELC:

Elective laparoscopic cholecystectomy

ERPs:

Enhanced recovery protocols

RTS:

Returns to system

MME:

Mean morphine equivalents

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Author information

Authors and Affiliations

  1. Department of Surgery, Emory University, Atlanta, GA, USA

    Goeto Dantes

  2. Department of Pediatrics, Children’s Healthcare of Atlanta, GI Care for Kids, Atlanta, GA, USA

    Olivia A. Keane

  3. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Matthew S. Clifton & Kurt F. Heiss

  4. Emory University School of Medicine, Emory University, Atlanta, GA, USA

    Matthew Margol, Oluwatoyin Thompson & Gregory Darville

Authors
  1. Goeto Dantes
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  2. Olivia A. Keane
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  3. Matthew Margol
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  4. Oluwatoyin Thompson
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  5. Gregory Darville
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  6. Matthew S. Clifton
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  7. Kurt F. Heiss
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GD, OK, MM, OT and GD. The first draft of the manuscript was written by GoD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Previous communication

This manuscript submission is a revision of a previously submitted manuscript for publication with Pediatric Surgery International.

Corresponding author

Correspondence to Goeto Dantes.

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The authors declare no conflict of interest.

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Dantes, G., Keane, O.A., Margol, M. et al. Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic cholecystectomy surgery. Pediatr Surg Int 38, 1517–1523 (2022). https://doi.org/10.1007/s00383-022-05195-y

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  • DOI: https://doi.org/10.1007/s00383-022-05195-y

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