Abstract
Enhanced recovery after surgery (ERAS) protocols are standardized perioperative treatment plans aimed at improving recovery time in patients following surgery using a multidisciplinary team approach. These protocols have been shown to optimize pain control, improve mobility, and decrease postoperative ileus and other surgical complications, thereby leading to a reduction in length of stay and readmission rates. To date, no ERAS-based protocols have been developed specifically for pediatric patients undergoing oncologic surgery. Our objective is to describe the development of a novel protocol for pediatric, adolescent, and young adult surgical oncology patients. Our protocol includes the following components: preoperative counseling, optimization of nutrition status, minimization of opioids, meticulous titration of fluids, and early mobilization. We describe the planning and implementation challenges and the successes of our protocol. The effectiveness of our program in improving perioperative outcomes in this surgical population could lead to the adaptation of such protocols for similar populations at other centers and would lend support to the use of ERAS in the pediatric population overall.
Highlights
The timing of our ERP protocol for pediatric, adolescent, and young adult surgical oncology patients is outlined in Table 1 and described
While many more ERP cases are needed in order to determine the effectiveness of our program, our preliminary results seem to support these findings, as two ERP cases were discharged home on postoperative day two, and no or minimal opioids were required for pain management
While evidence for the effectiveness of Enhanced recovery after surgery (ERAS) protocols in pediatric cancer patients is lacking, positive results seen in other pediatric surgeries are encouraging
Summary
Enhanced recovery after surgery (ERAS) programs aim to use evidence-based practices to improve perioperative care. Patient-focused approach, ERAS programs strive to minimize the physiologic stress associated with selected surgeries in certain patient populations. There is abundant literature describing successful implementation of ERAS programs in adults. The evidence in pediatric surgical populations is not as robust [1]
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