A.J. Behrmann1, E. Shumway1, M. Kutmah1, T. Kempker2, V. Ramachandran1,2, A.I. Marwan1,2 1University of Missouri – Columbia School of Medicine, Columbia, MO, USA 2University of Missouri – Columbia School of Medicine, Division Of Pediatric General, Thoracic And Fetal Surgery, Department Of Surgery, Columbia, MO, USA
Introduction: Prenatal diagnosis of congenital lung lesions is now more common due to advancements in imaging technology. These developmental parenchymal and airway abnormalities can be safely removed via thoracoscopic lobectomy. Our institution recently implemented an enhanced recovery after surgery (ERAS) protocol (Figure 1) that demonstrates efficacy, safety, and promising improved outcomes.
Methods: A single-center retrospective chart review was conducted for the eighteen patients (eight ERAS, 10 non-ERAS) undergoing pediatric thoracoscopic lobectomy from 2014-2024. P values <0.05 were considered significant. Cohen’s d and Phi coefficient values are included to report effect size and strength of correlations, respectively.
Results: Patients in the ERAS group were younger at the time of surgery (ERAS: 4.4±2.9 months vs. non-ERAS: 6.7±7.1 months, P=0.17, Cohen’s d=0.44), though not significantly. Intubation duration was shorter in the ERAS group (ERAS: 0 days vs. non-ERAS: 1±2.4 days, P=0.07, Cohen’s d=0.53). After excluding two outliers in the non-ERAS group whose stay was prolonged due to medical and social events unrelated to surgery, postoperative length of stay (LOS) was still shorter in ERAS patients (ERAS: 2.0±0.53 days vs. non-ERAS: 5.3±3.8 days, P=0.03, Cohen’s d=1.9). Chest tube duration was also shorter in ERAS patients (ERAS: 1.5±0.7 days vs. non-ERAS: 4.9±3.3 days, P=0.01, Cohen’s d=1.4). None of the ERAS patients returned to the operating room due to a complication throughout their initial hospital stay, while three non-ERAS patients did (P=0.09, Phi=0.40). ERAS patients had no reintubations or air leaks, compared to four reintubations (P=0.04, Phi=0.48) and three air leaks (P=0.09, Phi=0.40) in the non-ERAS group. Crucially, there were no complications in the ERAS group, whereas five non-ERAS patients experienced Clavien-Dindo level III (one IIIa, four IIIb) complications (P=0.02, Phi=0.56).
Conclusion: Our preliminary findings suggest successful integration of a novel ERAS protocol in pediatric thoracoscopic lobectomies and its efficacy in reducing standard post-operative recovery times as well as the rate of complications. The 2-day earlier discharge in the ERAS group constitutes less healthcare burden with improved resource utilization and less family, work, and social disruption.