Improved Post-Operative Outcomes and Reduced Narcotic Use With ERAS Protocol in a Pediatric Ambulatory Surgery Setting.

Abstract

Compared to the adult literature, there are few enhanced recovery after surgery (ERAS) protocols standardized in the pediatric population. The objective of the current study is to determine if the implementation of an ERAS protocol would improve patient outcomes in the ambulatory pediatric urologic population. A retrospective analysis was performed on pediatric patients who underwent urologic procedures (circumcision, orchiopexy, hypospadias correction, and urethroplasty) in the ambulatory surgical setting affiliated with a tertiary pediatric hospital. Outcomes measured include opioid use, home pain control, time in recovery, need for rescue pain medications, and adverse events between pediatric patients receiving standard of care (n = 30) and pediatric patients receiving the ERAS protocol (n = 29). The application of the ERAS pathway led to significantly increased opioid-free care (7% vs. 43%, p < 0.01). There was a reduction in the cost of care, a trend toward reduced opioid use, a trend toward reduced PACU stays for ERAS patients, and families of ERAS patients reported a 100% rate of well-controlled pain at home. These changes occurred without any increased need for rescue pain medications (16% vs. 13%, p = 1) or any change in adverse events (0% vs. 0%, p = 1.0). Postoperative pain measures are improved in pediatric patients receiving the ERAS protocol in an ambulatory surgery setting when compared to patients receiving the standard of care, without an increased risk of adverse events or the need for rescue analgesia. Therefore, this work serves as a proof of concept that ERAS protocols can improve postoperative outcomes in the pediatric ambulatory surgical population.