Enhanced Recovery After Surgery for Pediatric Cleft Repair: A Systematic Review and Meta-Analysis

Abstract

Objective: Perform a systematic review assessing the efficacy of enhanced recovery after surgery (ERAS) protocols for cleft palate repair. Primary outcomes included hospital length of stay, readmission rates, and postoperative narcotic use. Secondary outcomes included complications, time to initial postoperative oral intake, and pain scores. Data Sources: Cohort and randomized studies of ERAS protocols pertaining to cleft palate repair were identified by systematic review of Medline, Scopus, Embase, and grey literature. Review Methods: Data extracted included patient demographics, clinical care protocols, complication rates, postoperative narcotic use, time to initial postoperative oral intake, hospital length of stay, family satisfaction, and 30-day readmission. Meta-analysis was used to compare outcomes between patients enrolled in ERAS protocols versus those in conventional care pathways. Results: Eight hundred sixty-five articles were screened, and 5 studies met full inclusion criteria. A total of 425 patients were included. Patients in ERAS protocols saw a mean reduction of – 23.96 hours in length of stay compared to controls (95% confidence interval [CI]: – 26.4, – 20.6). Patients in ERAS protocols also had decreased total morphine consumption (mean difference [MD]: – 3.88 mg; CI: – 4.31, – 3.45), and decreased time to first initial feed compared to controls (MD: – 3.88 hours; CI: – 4.3, – 3.5). There was no difference in readmission rates or complication rates between ERAS and control groups. Conclusions: ERAS protocols have seen limited use in pediatric patients. The present study sought to assess the impact of ERAS protocols following primary palatoplasty. Our results indicate decreased hospital length of stay, postoperative opioid consumption, and time to feeding, without increasing readmission rates or complication rates.

Liposomal Bupivacaine Use During Orthognathic Surgery in Cleft Lip and Palate Patients

“…Our results suggest that liposomal bupivacaine could potentially play a role in multimodal nonopioid pain management, particularly within the context of ERAS protocols—a subject of growing interest in ongoing research 5 . ERAS guidelines have been widely adopted across various surgical specialties; however, their application in adolescent patients remains limited 26 . In a 2022 systematic review assessing ERAS protocols for cleft palate repair, notable reductions in postoperative opioid consumption were observed in ERAS patients managed with multimodal analgesia, along with a decreased time to postoperative oral intake 26 .…”

“…5 ERAS guidelines have been widely adopted across various surgical specialties; however, their application in adolescent patients remains limited. 26 In a 2022 systematic review assessing ERAS protocols for cleft palate repair, notable reductions in postoperative opioid consumption were observed in ERAS patients managed with multimodal analgesia, along with a decreased time to postoperative oral intake. 26 Further research is needed in this area to delve deeper into the role of liposomal bupivacaine in adolescent multimodal pain management.…”

“…26 In a 2022 systematic review assessing ERAS protocols for cleft palate repair, notable reductions in postoperative opioid consumption were observed in ERAS patients managed with multimodal analgesia, along with a decreased time to postoperative oral intake. 26 Further research is needed in this area to delve deeper into the role of liposomal bupivacaine in adolescent multimodal pain management. Prospective studies should be conducted to investigate liposomal bupivacaine as a component of ERAS guidelines for orthognathic surgery, comparing outcomes to those of patients receiving standard nonopioid pain management.…”

Characterizing Interventions and Family Assistance of a Nurse Navigation Program in Orofacial Cleft Care

“…Enhanced recovery after surgery (ERAS) programs, for example, have been shown to eliminate disparities in postoperative length of stay in Black patients undergoing colorectal surgery. 51 ERAS protocols for cleft palate surgery have also demonstrated decreased length of stay and postoperative analgesia, 52 and may show similar promise towards this goal. Further, we will continue to utilize the best possible evidence to optimize our nurse navigator program to offer equitable outreach, family-assistance, and clinical follow-up for all patients.…”

Cleft Palate Repair Postoperative Management: Current Practices in the United States

“…This variation among surgeons in postoperative management may decrease with the adoption of Enhanced Recovery After Surgery (ERAS) programs, 16 which are gaining increased traction within surgical disciplines. Four ERAS programs for cleft palate repair have been recently published, 12,[17][18][19][20] which may signal ongoing efforts to standardize postoperative care within hospitals.…”