Enhancing recovery after minimally invasive repair of pectus excavatum

Litz, Cristen N.; Farach, Sandra M.; Fernández, Allison M.; Elliott, Ryan S.; Dolan, Jenny; Nelson, Will; Walford, Nebbie E.; Snyder, Christopher; Jacobs, Jeffrey P.; Amankwah, Ernest K.; Danielson, Paul D.; Chandler, Nicole M.

doi:10.1007/s00383-017-4148-6

Cited by 29 publications

(12 citation statements)

References 31 publications

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“…Enhanced recovery after surgery and ‘fast‐track’ surgery protocols are examples of successful procedure‐specific initiatives that have been successful . There is compelling evidence supporting value in clinical efficiency and outcomes for these initiatives in both adult and paediatric specialty fields …”

Section: Introductionmentioning

confidence: 99%

“…5,6 There is compelling evidence supporting value in clinical efficiency and outcomes for these initiatives in both adult and paediatric specialty fields. [7][8][9][10][11][12] Recent years have seen a proliferation of rationalized pathways for both uncomplicated and complicated appendicitis in children. Challenges in implementation include safeguarding high standards of patient safety and quality with expedited discharge and standardizing care pathways for a heterogeneous pathology that ranges in severity from early mild appendicitis to advanced disease with gross peritoneal soiling.…”

Section: Introductionmentioning

confidence: 99%

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Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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Background ‘Fast‐track’ surgery protocols aim to standardize and rationalize post‐operative care, with evidence of safety and efficacy in both uncomplicated and complicated childhood appendicitis. Generalization for broader adoption has been limited by variation in protocol design, including specific antibiotic choice, discharge criteria, post‐operative monitoring and patient selection. Methods A systematic review of the literature was performed to evaluate the current evidence underpinning fast‐track protocols for childhood appendicitis and identify areas of consensus and controversy. Results About 33 studies met the inclusion criteria, including four prospective observational studies, 20 case–control studies, seven cohort studies and two randomized controlled trials studying uncomplicated (n = 9), complicated (n = 18) and mixed cohorts (n = 6). Reduction in length of hospital stay was almost universally reported, with equivalent or improved complication rates. Key themes of protocols included antibiotic choice and duration, discharge criteria and post‐operative laboratory and radiographic testing. Rationalized analgesia is an underexplored aspect of protocol design, and a standardized definition of complicated appendicitis remains elusive. Conclusion Standardized care of childhood appendicitis has been shown to be safe and effective in several local and international centres. Next steps include investigation of a complicated appendicitis protocol that integrates rationalized analgesia in appendicectomy recovery, and development of a consistent classification scheme for complicated disease to aid in identification of amenable cohorts.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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“…Our protocol was modeled after many elements of the University of Virginia adult Thoracic Surgery ERP, which incorporates pre-operative education, opioid-sparing analgesia, rib blocks with LB, and early ambulation (19). There is a growing interest in ERP and fast-track protocols in pediatric surgery, with the aims to minimize the physiologic and psychological stress of surgery, improve patient experience and decrease hospital length of stay (2,(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

A multimodal protocol utilizing liposomal bupivacaine rib blocks leads to opioid reduction in patients undergoing the Nuss procedure

Eubanks¹,

Grabski²,

Pollack³

et al. 2021

J Thorac Dis

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“…Minimally invasive surgeries have decreased LOS and opioids administered via PCA and/or NCA. 21,22 In the past decade, there has been an emphasis on opioid-sparing analgesic approaches, including regional anesthesia, acetaminophen (including IV), nonsteroidal anti-inflammatory drugs, gabapentin, and low-dose ketamine. 24,25 The use of local anesthetic infusions via peripheral nerve catheters increased ∼10-fold (2003-2016).…”

Section: Discussionmentioning

confidence: 99%

Patient- and Nurse-Controlled Analgesia: 22-Year Experience in a Pediatric Hospital

Donado

Solodiuk

Rangel

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: Pediatric pain management has rapidly changed over the last 2 decades. In this study, we describe the changing practices and adverse events (AEs) related to patient-controlled analgesia (PCA) and/or nurse-controlled analgesia (NCA) over a 22-year period. METHODS:After institutional review board approval, retrospective data from a single tertiary-care pediatric hospital were collected between 1994 and 2016. Subgroup analyses were done for surgical and medical case patients. We reported the number of times that PCA and/or NCA was ordered annually, the median and interquartile ranges for age, PCA and/or NCA duration and length of stay, and AE frequencies.RESULTS: Over 22 years, 32 338 PCAs and/or NCAs were ordered in this institution. Morphine and hydromorphone were used most commonly. Between 1994 and 2006, initial orders for PCA and/or NCA increased 2.5-fold. After 2007, initial orders for PCA and/or NCA rapidly decreased; after 2013, the decrease continued at a slower rate, with a total of 1007 orders in 2016. This decrease occurred despite increased hospital admissions and surgeries. Between 2007 and 2012, peripheral nerve blocks rapidly increased (10-fold). After 2002, 146 AEs were reported (1.0%). Of those, 50.5% were nonintercepted, and 20.6% were intercepted AEs; 5.5% and 6.2% were preventable and nonpreventable AEs, respectively.CONCLUSIONS: PCA and/or NCA usage continues to be common in pediatric patients, although usage has declined and stabilized in the setting of other emerging methods of analgesia and increases in the number of minimally invasive surgical procedures. The overall rate of AEs was extremely low. However, improvements to eliminate all errors are needed, especially with medications with a great risk of harm (such as opioids).

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Enhancing recovery after minimally invasive repair of pectus excavatum

Abstract: The implementation of an enhanced recovery pathway is a feasible and effective way to reduce resource utilization and improve outcomes in pediatric patients who undergo minimally invasive repair of pectus excavatum.

Cited by 29 publications

References 31 publications

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

A multimodal protocol utilizing liposomal bupivacaine rib blocks leads to opioid reduction in patients undergoing the Nuss procedure

Patient- and Nurse-Controlled Analgesia: 22-Year Experience in a Pediatric Hospital

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