Sustained Outcomes After Enhanced Recovery Pathway Implementation in Pediatric Colorectal Surgery.

Introduction: Previous studies have demonstrated improvements in length of stay and opioid utilization after implementing Enhanced Recovery After Surgery Pathways (ERPs) for pediatric colorectal surgery. However, the long-term impact of ERPs on postoperative outcomes following the implementation of specific ERP components has not been examined.

Methods: In this single-institution retrospective and longitudinal cohort review of pediatric patients undergoing colorectal surgery before (Pre-ERP - 4/2014-8/2015) and after an ERP implementation (ERP - 9/2015-1/2024). Poisson regression was performed to determine the role of pathway implementation on length of stay (LOS), opioid utilization total (OU) (morphine milliequivalents/kilogram), indwelling urinary catheter use, total intravenous fluid (IVF) use, and time to PO intake. Secondary analysis compared patients during implementation (9/2015-4/2020) and sustainment periods (5/2020-1/2024) to report long-term ERP impacts.

Results: On multivariable regression, LOS for ERP patients was lower than for pre-ERP patients, and OU was almost half the pre-ERP OU (p≤0.01). The ERP cohort also had shorter indwelling urinary catheter duration, less IVF volume, and shorter time to PO intake. Secondary analysis found that these effects improved further in the post-ERP sustainment phase.

Conclusion: To our knowledge, this represents the largest single-institution study to date of children ≤18 years old who underwent colorectal surgery before and after ERP implementation. There were significant improvements in LOS, OU, urinary catheter duration, time to PO intake, and IVF use. This is the first study to report the impact of ERPs after implementation during sustainment and emphasizes the importance of ERPs in optimizing pediatric surgical outcomes for children undergoing colorectal surgery.

Type of study: Retrospective cohort study LEVEL OF EVIDENCE: Level III.