Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma

Infographic · Mar 2026 · 1 min read

In brief

Multi-institutional study demonstrates that ERAS protocols in pediatric neuroblastoma resection reduce hospital stay from 6.9 to 3.7 days, decrease complications from 96% to 39%, and cut opioid use by 61%. Early diet advancement and ambulation are key drivers of improved outcomes in this complex surgical population.

ERAS protocol reduced post-op complications from 96% to 39% in pediatric neuroblastoma resection patients
Length of stay decreased by 3.2 days (6.9 to 3.7 days) with ERAS implementation across three institutions
Post-operative opioid use cut by 61% (0.54 to 0.21 MME mg/kg/day) with standardized ERAS pathway
Nasogastric tube use dropped from 92% to 17%; patients advanced to regular diet 3 days earlier with ERAS
Multi-institutional ERAS protocol is feasible and beneficial for complex pediatric oncologic abdominal surgery

Written by the GCMD Library team from the infographic.

The infographic uses a teal, yellow, and white color scheme with cartoon illustrations of hospitals, medical staff, and patients. Data is presented in contrasting red (historic cohort) and green (ERAS cohort) text to highlight improvements. The layout flows from study overview at top, to outcome metrics in the middle, to conclusion at bottom.

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

Background: Enhanced recovery after surgery (ERAS) pathways are multidisciplinary strategies to return patients to their physiologic baseline as efficiently as possible. This study aims to evaluate the feasibility and benefits of an ERAS pathway in children undergoing resection of abdominal neuroblastoma.

Methods: After IRB approval, all patients greater than 1 month old undergoing resection of an abdominal neuroblastoma at one of three children's hospitals between 2020 and 2022 were offered enrollment. A standardized ERAS protocol was utilized at all institutions. Data were prospectively recorded. We compared the prospective cohort to a historic cohort (2014-2020). Fisher's exact and t-tests were used, as appropriate.

Results: The study included 23 patients in the ERAS group compared to 24 historic patients. Post-operative nasogastric tube use decreased from 91.7% pre-ERAS to 16.7% in the ERAS cohort. ERAS patients were advanced to regular diets and ambulated 3 days earlier than pre-ERAS. Post-operative opioid consumption decreased from 0.54 to 0.21 milligram morphine equivalents (MME) mg/kg/day (p = 0.047). All but one patient (23, 96%) in the pre-ERAS cohort experienced at least one post-operative complication, compared to only nine (39.1%) in the ERAS cohort (p < 0.001). Average length of stay was 3.7 days with ERAS compared to 6.9 days pre-ERAS (p = 0.004).

Discussion: ERAS is associated with improvements in length of stay and a decrease in complications following resection of abdominal neuroblastoma. Children with neuroblastoma stand to benefit considerably from the benefits associated with the use of an ERAS protocol, given their intensive treatment, complex surgeries, and need for expeditious recovery.

The text in the image

Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma | 3 Children's Hospitals | 47 children age >1 month undergoing resection of abdominal neuroblastoma | ERAS cohort 2020-2022 23 patients | Historic cohort 2014-2020 24 patients | ERAS pathways are improving outcomes | Opioid use: 0.54 → 0.21 MME mg/kg/day | ≥1 post-op complications: 96% → 39.1% | Post-op NG tube use: 91.7% → 16.7% | Length of stay: 6.9 days → 3.7 days | Conclusion: Implementation of an ERAS pathway significantly reduced complications, opioid use, and hospital length of stay after abdominal neuroblastoma resection. | https://pubmed.ncbi.nlm.nih.gov/40781829/ | Mansfield SA et. al. | Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, United States | @LizzyPAC8 @globalcastmd @StayCurrentMD | Cincinnati Children's