Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma
Timestops
0:00
Introduction to ERAS Protocol for Neuroblastoma
Doctor Sophia Schermerhorn introduces the ERAS protocol for neuroblastoma, highlighting its structure and the evidence-based elements involved in the perioperative process.
0:08
Key Components of the ERAS Protocol
Discussion on the specific components of the ERAS protocol, including preoperative counseling, hydration loading, and multimodal analgesia.
0:17
Impact on Length of Stay
Analysis of how the ERAS protocol reduced the length of hospital stay from 7 days to 3.7 days.
0:26
Reduction in Opioid Use
Examination of the significant decrease in post-operative opioid use among patients following the ERAS protocol.
0:35
Early Resumption of Diet and Mobility
Overview of how patients were able to resume regular diets and ambulate earlier due to the ERAS protocol.
0:44
Decrease in Postoperative Complications
Highlighting the reduction in postoperative complications by over 50% as a result of implementing the ERAS protocol.
0:53
Quicker Clearance for Adjuvant Chemotherapy
Discussion on how patients were cleared to resume adjuvant chemotherapy earlier, contributing to improved overall care.
1:02
Conclusion and Implications for Future Care
Summarizing the key takeaways from the study and the implications of the ERAS protocol for standardizing perioperative care in neuroblastoma surgeries.
Topic overview
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.
Intended audience: Healthcare professionals and clinicians.
Categories
Specialty
Disease/Condition
Procedure/Intervention
Population
Clinical Task
Keywords
ERAS protocol
neuroblastoma
abdominal resection
perioperative process
preoperative counseling
hydration loading
multimodal analgesia
early feeding
early mobilization
length of stay
post-operative complications
opioid use
adjuvant chemotherapy
recovery
standardized care
prospective study
evidence-based elements
patient outcomes
surgical recovery
pediatric surgery
Hashtags
#ERAS
#Neuroblastoma
#PediatricSurgery
#PerioperativeCare
#MultimodalAnalgesia
#PostoperativeRecovery
#HydrationLoading
#EarlyMobilization
#EvidenceBasedMedicine
#SurgicalOutcomes
#PainManagement
#PatientCare
#Surgery
#Oncology
#Healthcare
#ClinicalResearch
#Pediatrics
#StandardizedCare
#PostoperativeComplications
#Recovery
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