Utilization of Enhanced Recovery After Surgery (ERAS) protocol in pediatric laparoscopic sleeve gastrectomy: a quality improvement project
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In brief
In brief
This quality improvement study demonstrates successful implementation of a comprehensive ERAS protocol for adolescents undergoing laparoscopic sleeve gastrectomy, incorporating carbohydrate loading, multimodal analgesia with intraoperative lidocaine infusion, and early mobilization. Results showed significantly reduced hospital length of stay, faster time to oral intake, and decreased anti-emetic use without increased complications.
- ERAS protocol in pediatric LSG reduced hospital stay from 54 to 33 hours without increasing complications or readmissions.
- Early oral intake achieved at 3 hours post-op vs 5.5 hours pre-ERAS, with 50% reduction in rescue anti-emetic requirements.
- Comprehensive ERAS elements including carbohydrate loading, lidocaine infusion, and multimodal analgesia are feasible in adolescent bariatric surgery.
- Adult ERAS protocols can be successfully adapted for pediatric metabolic and bariatric surgery populations.
- Opioid consumption and pain scores remained unchanged, suggesting ERAS benefits derive from anti-emetic control and early mobilization.
Written by the GCMD Library team from the article.
Abstract
Background
The obesity epidemic has led to an increased number of adolescents requiring metabolic and bariatric surgery (MBS), but there is paucity of data on the impact of implementing all aspects of Enhanced Recovery After Surgery (ERAS) protocols to improve outcomes in this population.
Methods
We implemented a comprehensive ERAS pathway for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Key elements included pre-operative fasting with carbohydrate loading in the morning of surgery, comprehensive anti-emetic and analgesic regimens including intra-operative lidocaine infusion (initiated before formal ERAS launch), regional anesthesia, and early goal-directed ambulation. We tracked opioid utilization, rescue anti-emetic use, time to oral intake, and hospital length of stay (HLOS) as outcome measures, and post-operative pain and returns to the system as balancing measures.
Results
Eighty-six patients (52 patients pre-ERAS and 34 patients post-ERAS) underwent LSG with no differences in demographics. The post-ERAS group had earlier time to oral intake (3.0 vs. 5.5 h, p = 0.003), used less rescue anti-emetics, (8.0 vs. 16.0 mg, p < 0.001), and had shorter HLOS (33 vs. 54 h, p < 0.001) but no difference in opioid use (0.370 vs. 0.435 MME/kg, p = 0.17), post-operative pain scores or return to the system.
Conclusions
Our novel use of bariatric-specific ERAS protocol with intra-operative lidocaine infusion accelerates the time to goal-directed oral intake and decreases HLOS without increasing the rate of returns to the system. This study highlights the feasibility and effectiveness of adapting adult ERAS protocols to the pediatric MBS population.
Level of evidence
Level III.