S. L. Werth1, N. B. Hebballi1, K. Tsao1, A. L. Speer1 1McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston), Department Of Pediatric Surgery, Houston, TX, USA
Introduction:
Enhanced Recovery After Surgery (ERAS) guidelines are well received in adult surgical care and have reduced complications, length of stay (LOS), and cost. However, there is a paucity of literature demonstrating benefit in pediatrics. The translation of ERAS guidelines to neonates is challenging due to physiological differences and a unique perioperative care team. Our aim is to address this knowledge gap by determining the adherence to the 2020 proposed ERAS guidelines for perioperative care in neonatal intestinal surgery at our institution and evaluating postoperative outcomes.
Methods:
A retrospective chart review was conducted of patients <1 year who underwent elective ostomy takedown at a single center tertiary children’s hospital between 2013-2023. Patients with intestinal failure were excluded. Demographics, nutrition, clinical course, operative details, pain management, and postoperative outcomes were analyzed. Descriptive statistics, chi-square and Fisher’s exact tests were conducted, and the statistical significance level was set at <0.05.
Results:
193 patients, 94 neonates and 99 infants, met inclusion criteria. 40% of neonates and 64% of infants were males with a median gestational age of 28 (IQR 24-34) vs 37 (IQR 34-38) weeks. Median birth weight was 1035 (IQR 704-2038) vs 2805 (IQR 2045-3410) grams for neonates and infants with a median age at surgery of 95 (IQR 66-118) vs 204 (IQR 152-274) days. The most common diagnoses in neonates were necrotizing enterocolitis (38%) and spontaneous intestinal perforation (31%), whereas in infants, 49% had anorectal malformation. 97% of neonates and 99% of infants received appropriate prophylactic antibiotics <60 min prior to incision; whereas, 67% vs 79% received postoperative antibiotics for >24 hrs. Although bair huggers were used in 99% of neonates and 98% of infants, intraoperative hypothermia (<36.5 C) occurred in 87% vs 85%. Median surgery time was similar 138 (IQR 112-178) vs 132 (IQR 101-178) min. Regional blocks (6% vs 27%) and acetaminophen (53% vs 93%) were more commonly used in infants, whereas most patients received opioids (96% neonates and 86% infants). Nutrition management and postoperative outcomes are listed in Table 1.
Conclusion:
Neonates and infants undergoing ostomy takedown at our institution had variable adherence to ERAS guidelines with a significant difference in nutrition management and postoperative outcomes. Specifically, neonates had delayed enteral feeding, increased surgical site infections, and prolonged LOS. We identified areas for quality improvement including intraoperative hypothermia, opioid use, and nutrition management. The implementation of ERAS guidelines in neonates may improve patient outcomes.
