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Erschienen in:

11.08.2022 | Review Article

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

verfasst von: Goeto Dantes, Olivia A. Keane, Matthew Margol, Oluwatoyin Thompson, Gregory Darville, Matthew S. Clifton, Kurt F. Heiss

Erschienen in: Pediatric Surgery International | Ausgabe 11/2022

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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.

Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N et al (2012) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 37(2):259–284. https://doi.org/10.1007/s00268-012-1772-0CrossRef

Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M et al (2014) Consensus guidelines for enhanced recovery after gastrectomy. Br J Surg 101(10):1209–1229. https://doi.org/10.1002/bjs.9582CrossRefPubMed

Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M et al (2013) Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations. Clin Nutr 32(6):879–887. https://doi.org/10.1016/j.clnu.2013.09.014CrossRefPubMed

Lassen K, Coolsen MM, Slim K, Carli F, Aguilar-Nascimento JE, Schäfer M et al (2012) Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr 31(6):817–830. https://doi.org/10.1016/j.clnu.2012.08.011CrossRefPubMed

Nygren J, Thacker J, Carli F, Fearon K, Norderval S, Lobo D et al (2012) Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr 31(6):801–816. https://doi.org/10.1016/j.clnu.2012.08.012CrossRefPubMed

Short HL, Heiss KF, Burch K, Travers C, Edney J, Venable C, Raval MV (2018) Implementation of an enhanced recovery protocol in pediatric colorectal surgery. J Pediatr Surg 53(4):688–692. https://doi.org/10.1016/j.jpedsurg.2017.05.004CrossRefPubMed

Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–440. https://doi.org/10.1016/j.clnu.2010.01.004CrossRefPubMed

Bogue CO, Murphy AJ, Gerstle JT, Moineddin R, Daneman A (2010) Risk factors, complications, and outcomes of gallstones in children: a single-center review. J Pediatr Gastroenterol Nutr 50(3):303–308. https://doi.org/10.1097/mpg.0b013e3181b99c72CrossRefPubMed

Yeh A, Butler G, Strotmeyer S, Austin K, Visoiu M, Cladis F, Malek M (2020) ERAS protocol for pediatric laparoscopic cholecystectomy promotes safe and early discharge. J Pediatr Surg 55(1):96–100. https://doi.org/10.1016/j.jpedsurg.2019.09.053CrossRefPubMed

10.

Scott MJ, Baldini G, Fearon KC, Feldheiser A, Feldman LS, Gan TJ et al (2015) Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand 59(10):1212–1231. https://doi.org/10.1111/aas.12601CrossRefPubMedPubMedCentral

11.

Baxter KJ, Short HL, Wetzel M, Steinberg RS, Heiss KF, Raval MV (2019) Decreased opioid prescribing in children using an enhanced recovery protocol. J Pediatr Surg 54(6):1104–1107. https://doi.org/10.1016/j.jpedsurg.2019.02.044CrossRefPubMed

12.

Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS (2011) Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics 129(1):e82–e88. https://doi.org/10.1542/peds.2011-0579CrossRefPubMed

13.

Gurusamy K, Junnarkar S, Farouk M, Davidson BR (2008) Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy. Br J Surg 95(2):161–168. https://doi.org/10.1002/bjs.6105CrossRefPubMed

14.

Gould JL, Poola AS, Peter SD, Aguayo P (2016) Same day discharge protocol implementation trends in laparoscopic cholecystectomy in pediatric patients. J Pediatr Surg 51(12):1936–1938. https://doi.org/10.1016/j.jpedsurg.2016.09.008CrossRefPubMed

15.

Vaughan J, Gurusamy KS, Davidson BR (2013) Day-surgery versus overnight stay surgery for laparoscopic cholecystectomy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd006798.pub4CrossRefPubMed

16.

Nechay T, Titkova S, Tyagunov A, Anurov M, Sazhin A (2021) Modified enhanced recovery after surgery protocol in patients with acute cholecystitis: efficacy, safety and feasibility. Multicenter randomized control study. Updates Surg 73(4):1407–1417. https://doi.org/10.1007/s13304-021-01031-5CrossRefPubMed

Titel: Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic cholecystectomy surgery
verfasst von: Goeto Dantes
Olivia A. Keane
Matthew Margol
Oluwatoyin Thompson
Gregory Darville
Matthew S. Clifton
Kurt F. Heiss
Publikationsdatum: 11.08.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 11/2022
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05195-y

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