Implementation of Enhanced Recovery Protocols Reduces Opioid Use in Pediatric Laparoscopic Heller Myotomy Surgery
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Read the article on jpedsurg.org ↗Article · Feb 2022 · 1 min read
In brief
In brief
Implementation of enhanced recovery protocols in pediatric laparoscopic Heller myotomy significantly reduced opioid use, with 57% of post-ERP patients requiring no opioids during admission versus 25% pre-ERP. The protocol safely decreased both inpatient morphine equivalents and discharge opioid prescriptions without compromising outcomes.
Written by the GCMD Library team from the article.
Background
: Enhanced recovery protocols (ERPs) are effective means of standardizing and improving the quality of surgical care in adults. Our purpose was to retrospectively compare outcomes before and after implementation of ERPs in children undergoing laparoscopic Heller myotomy for achalasia.
Methods
: A pediatric-specific ERP was used for children undergoing laparoscopic Heller myotomy starting July 2017 at two pediatric surgery centers within a single metropolitan healthcare system. A retrospective review of 8 patients undergoing Heller myotomies between July 2014 and July 2017 was performed as a control. This cohort was compared to 14 patients managed post-ERP implementation (2017-2020). Outcomes of interest investigated included opioid use during admission, narcotics at discharge, time to regular diet, length of stay (LOS), and readmissions.
Results
: There was a significant decrease in opioid use both while in the hospital and at time of discharge. Mean morphine equivalent use was 4.50 mg in the pre-ERP cohort and 1.97 mg in the post-ERP cohort. Furthermore, 8 out of 14 (57%) patients in the post-ERP cohort received no opioids during the admission compared with only 2 out of 8 (25%) patients in the pre-ERP cohort. Only 1 out of 14 (7.14%) patients in the post-ERP cohort was discharged with a prescription for opioid medication while 6 out of 8 (75%) in the pre-ERP cohort were discharged with an opiate prescription.
Conclusions
: The use of ERP in children undergoing laparoscopic Heller myotomy surgery is safe and effective and leads to a reduction in opioid use during admission and at discharge.