Enhanced Recovery After Surgery for Pediatric Abdominal Tumor Resections: A Prospective Multi-institution Study

Abstract

Background

Enhanced recovery after surgery (ERAS) protocols are multi-disciplinary approaches to standardize perioperative care. This is the first prospective, multi-institutional study to evaluate ERAS in pediatric patients undergoing abdominal tumor resections.

Methods

All patients >1-month-old undergoing abdominal tumor resection at one of three children’s hospitals between 2020 and 2022 were eligible. ERAS counseling was performed, and informed consent obtained. The ERAS protocol was standardized across institutions. We compared the prospective cohort to a propensity-matched historical cohort (2014–2020) from each institution utilizing 16 variables. Categorical variables were compared using McNemar’s and/or Stuart–Maxwell testing. Continuous data was compared using logistic regression.

Results

Ninety-five patients enrolled in the prospective cohort and were compared to 95 well-matched historic patients. Median LOS was 5.3 (4.1–7.2) days in the historic cohort, and 4.3 (3.3–6.2) days in the ERAS cohort (p = 0.053). Post-operative opioid consumption was lower in ERAS patients at 0.08 (0.03–0.16) MME mg/kg/day versus 0.23 (0.12–0.52) in historic patients (p = 0.013). ERAS patients received clear (POD#0, 0-0) and regular (POD#1, 1.0–1.0) diets two days sooner (both p < 0.001). ERAS patients ambulated two days sooner (1.0, 1.0–2.0 versus 3.0, 2.0–5.0). The number of patients who experienced any complication was significantly lower in the ERAS cohort (44, 44.2 %) compared to historic (82, 86.3 %, p < 0.001). This reduction was seen across each Clavien-Dindo grade 1–3 category (all p < 0.05).

Conclusion

ERAS protocols are feasible in pediatric patients undergoing abdominal tumor resections. Use of an ERAS protocol significantly reduced complications, opioid consumption, time to mobility, and time to diets.

Level of Evidence

II.