Application of enhanced recovery after surgery for perioperative management of intestinal duplication in children

Abstract

Objective To explore the safety and effectiveness of employing the model of enhanced recovery after surgery (ERAS) for perioperative management of intestinal duplication in children. Methods A total of 38 children hospitalized with intestinal duplication at Tianjin Children's Hospital and Urumqi Children's Hospital were analyzed retrospectively from January 2015 to January 2019. According to different perioperative management methods, 18 children undergoing open surgery with traditional perioperative management mode were selected as the control group. From January 2015 to July 2017, 20 children undergoing minimally invasive surgery with ERAS management mode were included into the study group (ERAS group). The parameters of operative duration, intraoperative blood loss, time of initial intake of water/feeding/defecation, duration of parenteral nutrition, occurrence of postoperative complications (anastomotic leakage, postoperative bleeding, intestinal obstruction, wound infection & respiratory infection), hospitalization time, hospitalization expenses and parental satisfaction of patients were compared between two groups. Results No significant inter-group difference existed in age, admission weight, preoperative nutritional status, operative duration, intraoperative blood loss or occurrence of postoperative complications (P>0.05). ERAS and control groups were compared in terms of postoperative time of initial intake of water [(25.90±4.53) vs. (103.00±8.94) hours, P<0.001], feeding [(36.90±4.42) vs. (127.28±6.52) hours, P<0.001], defecation [(35.45±7.05) vs. (43.56±10.38) hours, P<0.05], parenteral nutrition duration [(7.05±0.83) vs. (10.06±0.80) days, P<0.05] and hospitalization time [(9.26±0.59) vs. (11.64±1.91) days, P<0.001] and hospitalization expenses [(14 627.71±478.36) vs. (16 493.28±511.46) yuan]. The differences were statistically significant (P<0.05 or P<0.001). The satisfaction of families of ERAS group was significantly higher than that of control group (92.06% vs. 79.36%, P=0.037). Conclusions The management mode of ERAS is both safe and effective for perioperative period of intestinal duplication in children. It may reduce trauma stress, promote postoperative rehabilitation, shorten hospitalization time, lower hospitalization expenses and improve the satisfaction of children's families. Key words: Enhanced recovery after surgery; Intestinal duplication; Safety; Children