Enhancing recovery in pediatric surgery: a review of the literature

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• 作者：Julia K. Shinnick ; BA^a ; Heather L. Short ; MD^a ; Kurt F. Heiss ; MD^a ; Matthew T. Santore ; MD^a ; Martin L. Blakely ; MD ; MSCR^b ; Mehul V. Raval ; MD ; MS^a ; ^{mehulvraval@emory.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Pediatric surgery ; Enhanced recovery protocols ; Fast-track protocols ; Quality improvement
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：1 May 2016
• 年：2016
• 卷：202
• 期：1
• 页码：165-176
• 全文大小：643 K

文摘

Enhanced recovery after surgery (ERAS), guidelines entail a strategy of perioperative management proven to hasten postoperative recovery and reduce complications in adult populations. Relatively few studies have investigated the applicability of this paradigm to pediatric populations. Our objective was to perform a systematic review of existing evidence regarding the use and efficacy of enhanced recovery protocols (ERPs) in the pediatric population.

Materials and methods

Data were collected through a PubMed/MEDLINE literature search. Study eligibility criteria included a pediatric population and implementation of at least four components of published ERAS Society recommendations.

Results

One retrospective and four prospective cohort studies evaluating children undergoing gastrointestinal, urologic, and thoracic surgeries were identified. The overall quality of reporting was fair with few studies acknowledging limitations and bias and inconsistent outcome reporting. Studies included six or fewer interventions compared to 20 recommended interventions in most adult ERAS Society guidelines. None of the studies were well controlled. Nevertheless, these studies suggest that ERPs applied to the appropriate pediatric surgical populations may be associated with decreased length of stay, decreased narcotic use, and no detectable increase in complications.

Conclusions

There is a paucity of high-quality literature evaluating implementation of ERPs in pediatric populations. The limited literature available indicates that ERPs would be safe and potentially effective. More studies are needed to assess the efficacy of ERPs in pediatric surgery.