Pediatric Surgery – Enhanced Recovery for Pediatric Surgery

There is limited data on enhanced recovery pathways for pediatric surgery. There are multiple published reports discussing streamlining patient care with the use of protocols. Many of the aspects of enhanced recovery in the adult population have long been adopted by pediatric surgery. For example, preoperatively, pediatric patients routinely may have clears and/or breast milk until 2-3 hours prior to the procedures. The use of bowel preparations is quite variable depending on the surgical procedure, surgeon preference and the underlying pathologic diagnosis. Intraoperatively, normothermia has always been a priority in children. We often avoid tubes, drains, and lines in the pediatric patient especially Foley catheters. Immediate mobilization and multimodal analgesia with use of acetaminophen and NSAIDS is often routine in pediatric surgery.

Pediatric enhanced recovery has focused mostly on abdominal procedures. Children undergoing elective bowel resection for inflammatory bowel disease (IBD) often have a longer hospitalizations, are slower to start solid diet, and slower to mobilize with the same time to restoration of bowel function. [1]
Enhanced recovery in children has been applied to:

-Appendectomy
-Bowel anastomosis
-Fundoplication
-Hypospadias
-Nephrectomy
-Pyeloplasty

These patients treated within an enhanced recovery pathway demonstrated no complications, shorter hospitalization, and good patient and parent satisfaction scores. Pain scores varied. [2,3] Schukfeh et al reported using a fast-track protocol for pediatric patients undergoing appendectomy, hypospadias repair, pyloromyotomy and fundoplication with no complications, same length of hospitalization and good parental satisfaction scores. [4].


References:
1. West MA1, Horwood JF, Staves S, Jones C, Goulden MR, Minford J, Lamont G, Baillie CT, Rooney PS. Potential benefits of fast-track concepts in paediatric colorectal surgery. J Pediatr Surg. 2013 Sep;48(9):1924-30.

2. Reismann M, von Kampen M, Laupichler B, Suempelmann R, Schmidt AI, Ure BM. Fast-track surgery in infants and children.

J Pediatr Surg. 2007 Jan;42(1):234-8.

3. Reismann M, Dingemann J, Wolters M, Laupichler B, Suempelmann R, Ure BM. Fast-track concepts in routine pediatric surgery: a prospective study in 436 infants and children.
Langenbecks Arch Surg. 2009 May;394(3):529-33.

4. Schukfeh N, Reismann M, Ludwikowski B, Hofmann AD, Kaemmerer A, Metzelder ML, Ure B. Implementation of fast-track pediatric surgery in a German nonacademic institution without previous fast-track experience. Eur J Pediatr Surg. 2014 Oct;24(5):419-25.



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