Appropriateness of a pediatric-specific enhanced recovery protocol using a modified Delphi process and multidisciplinary expert panel

Short, Heather L.; Taylor, Natalie; Piper, Kaitlin; Raval, Mehul V.

doi:10.1016/j.jpedsurg.2017.09.008

Cited by 59 publications

(26 citation statements)

References 30 publications

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“…These results might be due to the combination of the core ERAS elements, such as early enteral nutrition (EN), judicious fluid therapy, enforced postoperative mobilization, and preferential use of non-opioid analgesia in the modified ERAS pathway. [ 19 ] When implementing this program, a multidisciplinary team, including surgeons, anesthesiologists, nurses, physiotherapist, and nutritionists, is indispensable. Unless contraindicated, early enteral nutrition has been encouraged to be initiated as early as possible, with several benefits, including modulating the inflammatory response and metabolism and preserving gut integrity, thereby dampening postoperative ileus (POI).…”

Section: Discussionmentioning

confidence: 99%

Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer

2018

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Enhanced recovery after surgery (ERAS) is acknowledged to reduce perioperative stress in several surgical diseases. Here, we investigated whether modified ERAS is associated with beneficial effects in the setting of emergency colorectal surgery.We retrospectively evaluated the medical records of 839 consecutive patients with obstructive colorectal cancer undergoing surgical intervention at 4 institutes. Among them, 356 cases were managed with a multidisciplinary team approach to care (modified ERAS protocols), and the remaining 483 cases were treated based on traditional protocols. According to modified ERAS or traditional care, propensity score (PS) matching was performed to adjust biases in patient selection. The primary outcome was gastrointestinal function recovery. Secondary outcomes included postoperative complications and length of hospital stay.Modified ERAS was associated with postoperative gastrointestinal function recovery, including time to first flatus (P = .002), first defecation (P = .008), and prolonged ileus (P = .016). According to the Clavien–Dindo classification, fewer total episodes of grade II or higher postoperative complications were observed in patients cared for with modified ERAS than in patients with traditional care (P = .002). Median (interquartile range) postoperative hospital stay in the modified ERAS group was 6 (3–22) days versus 9 (7–27) days in the traditional care group (P < .001). Furthermore, the interval from operation to postoperative chemotherapy (d) was significantly shorter in the modified ERAS group (35.6 ± 11.5 vs 47.6 ± 23.8, P < .001).The modified ERAS was safe and associated with clinical benefits, including fast recovery of bowel function, reduced postoperative complications, and shorter hospital stay for patients with obstructive colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer

2018

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“…Avoidance of MBP was one of only two elements that the American Paediatric Surgical Association (APSA) ultimately excluded from their recommendations for an adolescent colorectal ERAS protocol (the other excluded element being glucose monitoring). 14 Conflicting literature and lack of definitive evidence were among the reasons for excluding avoiding MBP in the recommendation.…”

Section: Avoidance Of Preoperative Hyperosmotic Mechanical Bowel Preparationmentioning

confidence: 99%

Enhanced recovery after surgery in paediatrics: a review of the literature

2020

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“…[ 12 ] In fact, the development and evaluation of pediatric-specific enhance recovery protocols among a multidisciplinary expert panelists has been recently investigated. [ 13 ] As pediatric protocols develop, ERAS has the potential to extend to patient populations of various age groups. Thus, it is likely that as more evidence-based studies that elucidate the benefits of ERAS continue to be published in adult and pediatric populations, ERAS will continue to evolve and gain popularity.…”

Section: Who Should Receive Enhanced Recovery After Surgerymentioning

confidence: 99%