Implementation of an Enhanced Recovery After Surgery Protocol for Cleft Palate Repair

Abstract

Objective This study examines an Enhanced Recovery After Surgery (ERAS) protocol for patients with cleft palate and hypothesizes that patients who followed the protocol would have decreased hospital length of stay and decreased narcotic usage than those who did not. Design Retrospective cohort study. Setting The study takes place at a single tertiary children's hospital. Patients All patients who underwent cleft palate repair during a 10-year period (n = 242). Interventions All patients underwent cleft palate repair with the most recent cohort following a new ERAS protocol. Main Outcome Measures Primary outcomes included hospital length of stay and narcotic usage in the first 24 hours after surgery. Results Use of local bupivacaine during surgery was associated with decreased initial 24-hour morphine equivalent usage: 2.25 vs 3.38 mg morphine equivalent (MME) (P < 0.01), and a decreased hospital length of stay: 1.71 days vs 2.27 days (P < 0.01). The highest 24-hour morphine equivalent a patient consumed prior to the ERAS protocol implementation was 24.53 MME, compared with 6.3 MME after implementation. Utilization of the ERAS protocol was found to be associated with a decreased hospital length of stay: 1.67 vs 2.18 days (P < 0.01). Conclusions Use of the proposed ERAS protocol may lead to lower narcotic usage and decreased length of stay.