Enhanced recovery care versus traditional non-ERAS care following osteotomies in developmental dysplasia of the hip in children: a retrospective case-cohort study

Jin Li,Xin Tang,Pan Hong,Ruikang Liu,Renhao Ze,Saroj Rai

doi:10.1186/s12891-020-03243-z

Abstract

BackgroundEnhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopaedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group.MethodsThe ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups.ResultsThe mean duration of hospital stay was significantly reduced from 10.0 ± 3.1 in the traditional care group to 6.0 ± 0.8 days in the ERAS(P < 0.001). The average VAS score in the first 3 days was significantly lower in the ERAS group (2.9 ± 0.8) than the traditional non-ERAS group (4.0 ± 0.8) (P < 0.001). However, there was no significant difference in the frequency of break-out pain (VAS > 4) between two groups (29.5 ± 6.3 times vs.30.6 ± 6.5 times, P = 0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery.ConclusionThe ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

Highlights

Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields
ERAS program Based on the ERAS protocol adopted in the pediatric surgery and orthopaedics department, an ERAS protocol for pediatric orthopaedic surgery was developed following a series of discussions with experts from pediatric orthopaedic surgery, anesthesiology, pediatrics, and nurses from both the ward and operating room (OR)
Patients were administered with multimodal analgesia postoperatively including local infiltration of ropivacaine (2.0 mg/ml) around the incision, analgesia infusion pump based on the parental requirements, intravenous nonsteroidal anti-inflammatory for 3 days, and oral dexibuprofen oral suspension if necessary

Summary

Introduction

Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. The ERAS protocol is an evidence-based multidisciplinary perioperative approach, aiming to reduce the hospital stay, decrease the incidence of surgery-related complications, and promote early rehabilitation [3]. ERAS was adopted in high-volume standard procedures, such as primary hip and knee replacements. There are reports that the ERAS protocol is both safe and effective in orthopaedic surgeries [4,5,6]. A meta-analysis showed that ERAS could facilitate the rapid recovery of physiological function, reduce the incidence of perioperative complications, shorten the duration of hospital stay [7]

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