Enhanced recovery protocol for congenital duodenal obstruction – initial experiences with development and implementation

Abstract

Background The experience with Enhanced Recovery After Surgery® (ERAS®) protocols in neonatal intestinal surgery is very limited. We present the development and implementation of an Enhanced Recovery Protocol (ERP) designed specifically for neonates treated for congenital duodenal obstruction (CDO), and early outcome after implementation. Methods An ERP for CDO was developed and implemented. Experiences with ERP development and implementation are described. Early clinical outcome in patients treated before (January 2015–Descember 2020) and after (February 2022–September 2024) implementation were compared. Ethical approval was obtained. Results A multidisciplinary ERP team was established. The ERP for CDO was developed with stakeholder involvement. Implementation was challenging, but with close follow-up and frequent meetings with the involved medical disciplines, an overall ERP compliance of 80% was achieved for the 21 patients treated after implementation. Compared to 40 patients treated before ERP implementation (January 2015-Descember 2020), the use of minimally invasive surgery increased and time to first postoperative enteral and breast feed were reduced, without increasing the rate of postoperative complications. Conclusions This study presents an ERP specifically designed for CDO with a unique description of our experiences with the development and implementation process. Early results suggest that this ERP for CDO is feasible and safe.