Enhanced Recovery After Surgery for Pediatric Abdominal Tumor Resections: A Prospective Multi-institution Study

Sara A Mansfield; Meera Kotagal; Stephen J Hartman; Andrew J Murphy; Andrew M Davidoff; Brady Hogan; Darren Ha; Doralina L Anghelescu; Marc Mecoli; Nicholas G Cost; Kyle O Rove

doi:10.1016/j.jpedsurg.2024.162046

Enhanced Recovery After Surgery for Pediatric Abdominal Tumor Resections: A Prospective Multi-institution Study

J Pediatr Surg. 2024 Oct 31;60(2):162046. doi: 10.1016/j.jpedsurg.2024.162046. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address: Sara.Mansfield@nationwidechildrens.org.
² Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
⁴ Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA.
⁵ Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.
⁶ Division of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁷ Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO, USA.

PMID: 39520824
DOI: 10.1016/j.jpedsurg.2024.162046

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols are multi-disciplinary approaches to standardize perioperative care. This is the first prospective, multi-institutional study to evaluate ERAS in pediatric patients undergoing abdominal tumor resections.

Methods: All patients >1-month-old undergoing abdominal tumor resection at one of three children's hospitals between 2020 and 2022 were eligible. ERAS counseling was performed, and informed consent obtained. The ERAS protocol was standardized across institutions. We compared the prospective cohort to a propensity-matched historical cohort (2014-2020) from each institution utilizing 16 variables. Categorical variables were compared using McNemar's and/or Stuart-Maxwell testing. Continuous data was compared using logistic regression.

Results: Ninety-five patients enrolled in the prospective cohort and were compared to 95 well-matched historic patients. Median LOS was 5.3 (4.1-7.2) days in the historic cohort, and 4.3 (3.3-6.2) days in the ERAS cohort (p = 0.053). Post-operative opioid consumption was lower in ERAS patients at 0.08 (0.03-0.16) MME mg/kg/day versus 0.23 (0.12-0.52) in historic patients (p = 0.013). ERAS patients received clear (POD#0, 0-0) and regular (POD#1, 1.0-1.0) diets two days sooner (both p < 0.001). ERAS patients ambulated two days sooner (1.0, 1.0-2.0 versus 3.0, 2.0-5.0). The number of patients who experienced any complication was significantly lower in the ERAS cohort (44, 44.2 %) compared to historic (82, 86.3 %, p < 0.001). This reduction was seen across each Clavien-Dindo grade 1-3 category (all p < 0.05).

Conclusion: ERAS protocols are feasible in pediatric patients undergoing abdominal tumor resections. Use of an ERAS protocol significantly reduced complications, opioid consumption, time to mobility, and time to diets.

Level of evidence: II.

Keywords: Enhanced recovery after surgery; Pediatric surgical oncology.