Enhanced Recovery Care Versus Traditional Care After Surgery in Pediatric Patients with Inflammatory Bowel Disease: A Retrospective Case-Control Study

Overview

Journal Biomedicines

Specialty Biomedical Engineering

Date 2022 Sep 23

PMID 36140310

Authors

Valeria Dipasquale

Francesca Lagana

Serena Arrigo

Giuseppe Trimarchi

Carmelo Romeo

Giuseppe Navarra

Girolamo Mattioli

Paolo Gandullia

Claudio Romano

Affiliations

Soon will be listed here.

Abstract

This study reports the outcomes of an enhanced recovery after surgery (ERAS) protocol in pediatric inflammatory bowel disease (IBD) surgery. Children who underwent surgery for IBD at two academic referral centers from January 2016 to June 2021 were included. Preoperative counseling, early enteral feeding (Impact®, Nestlé Health Science, and early mobilization were all part of the ERAS protocol. The outcomes (timing of first defecation, postoperative complications, and length of hospital stay (LOS)) were compared to traditional perioperative regimens (non-ERAS group). Thirty-three children who had 61 abdominal surgeries for IBD were included. Forty (65.5%) surgical procedures were included in the non-ERAS group, and 21 (34.5%) were included in the ERAS group. The postoperative complication rate was significantly lower in the ERAS group than in the non-ERAS group (29.6% vs. 55%, p = 0.049). The first defecation occurred earlier in the ERAS group than in the non-ERAS group (p < 0.001). There was no significant intergroup difference in the LOS. The implementation of ERAS in pediatric IBD surgery resulted in better outcomes than traditional perioperative care, especially in terms of postoperative complication rate and bowel function recovery. Further pediatric studies are needed to validate these findings and support ERAS application in children.

Citing Articles

Editorial: Novel Therapeutic Approaches in Inflammatory Bowel Diseases.

Pallio G Biomedicines. 2023; 11(9).

PMID: 37760907 PMC: 10526183. DOI: 10.3390/biomedicines11092466.

References

Phillips M, Adamson W, E McLean S, Hance L, Lupa M, Pittenger S . Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding. J Pediatr Surg. 2019; 55(1):101-105. DOI: 10.1016/j.jpedsurg.2019.09.065. View

Short H, Taylor N, Piper K, Raval M . Appropriateness of a pediatric-specific enhanced recovery protocol using a modified Delphi process and multidisciplinary expert panel. J Pediatr Surg. 2017; 53(4):592-598. DOI: 10.1016/j.jpedsurg.2017.09.008. View

Rafeeqi T, Pearson E . Enhanced recovery after surgery in children. Transl Gastroenterol Hepatol. 2021; 6:46. PMC: 8343543. DOI: 10.21037/tgh-20-188. View

Ljungqvist O, Scott M, Fearon K . Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017; 152(3):292-298. DOI: 10.1001/jamasurg.2016.4952. View

Kain Z, Mayes L, Caldwell-Andrews A, Karas D, McClain B . Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006; 118(2):651-8. DOI: 10.1542/peds.2005-2920. View

Dipasquale V, Catena M, Paiano L, Trimarchi G, Romeo C, Navarra G . Colectomy and health-related Quality of Life in children with ulcerative colitis. Minerva Pediatr (Torino). 2020; 76(1):1-6. DOI: 10.23736/S2724-5276.20.05750-3. View

Waitzberg D, Saito H, Plank L, Jamieson G, Jagannath P, Hwang T . Postsurgical infections are reduced with specialized nutrition support. World J Surg. 2006; 30(8):1592-604. DOI: 10.1007/s00268-005-0657-x. View

Gao R, Yang H, Li Y, Meng L, Li Y, Sun B . Enhanced recovery after surgery in pediatric gastrointestinal surgery. J Int Med Res. 2019; 47(10):4815-4826. PMC: 6833409. DOI: 10.1177/0300060519865350. View

Nordenvall C, Rosvall O, Bottai M, Everhov A, Malmborg P, Smedby K . Surgical Treatment in Childhood-onset Inflammatory Bowel Disease-A Nationwide Register-based Study of 4695 Incident Patients in Sweden 2002-2014. J Crohns Colitis. 2017; 12(2):157-166. DOI: 10.1093/ecco-jcc/jjx132. View

10.

Jakobsen C, Bartek Jr J, Wewer V, Vind I, Munkholm P, Groen R . Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease--a population-based study. Aliment Pharmacol Ther. 2011; 34(10):1217-24. DOI: 10.1111/j.1365-2036.2011.04857.x. View

11.

Lee G, Hodin R . Applying Enhanced Recovery Pathways to Unique Patient Populations. Clin Colon Rectal Surg. 2019; 32(2):134-137. PMC: 6395174. DOI: 10.1055/s-0038-1676479. View

12.

Turunen P, Ashorn M, Auvinen A, Iltanen S, Huhtala H, Kolho K . Long-term health outcomes in pediatric inflammatory bowel disease: a population-based study. Inflamm Bowel Dis. 2008; 15(1):56-62. DOI: 10.1002/ibd.20558. View

13.

Baxter K, Short H, Wetzel M, Steinberg R, Heiss K, Raval M . Decreased opioid prescribing in children using an enhanced recovery protocol. J Pediatr Surg. 2019; 54(6):1104-1107. DOI: 10.1016/j.jpedsurg.2019.02.044. View

14.

Thiele R, Rea K, Turrentine F, Friel C, Hassinger T, McMurry T . Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015; 220(4):430-43. DOI: 10.1016/j.jamcollsurg.2014.12.042. View

15.

West M, Horwood J, Staves S, Jones C, Goulden M, Minford J . Potential benefits of fast-track concepts in paediatric colorectal surgery. J Pediatr Surg. 2013; 48(9):1924-30. DOI: 10.1016/j.jpedsurg.2013.02.063. View

16.

Miller T, Thacker J, White W, Mantyh C, Migaly J, Jin J . Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014; 118(5):1052-61. DOI: 10.1213/ANE.0000000000000206. View

17.

Wilmore D, Kehlet H . Management of patients in fast track surgery. BMJ. 2001; 322(7284):473-6. PMC: 1119685. DOI: 10.1136/bmj.322.7284.473. View

18.

Short S, Rollins M, Zobell S, Torres H, Guthery S . Decreased ER visits and readmissions after implementation of a standardized perioperative toolkit for children with IBD. J Pediatr Surg. 2021; 57(4):604-609. DOI: 10.1016/j.jpedsurg.2021.08.016. View

19.

Drover J, Dhaliwal R, Weitzel L, Wischmeyer P, Ochoa J, Heyland D . Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. 2011; 212(3):385-99, 399.e1. DOI: 10.1016/j.jamcollsurg.2010.10.016. View

20.

Levine A, Koletzko S, Turner D, Escher J, Cucchiara S, de Ridder L . ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2013; 58(6):795-806. DOI: 10.1097/MPG.0000000000000239. View