BOB Ped Surg 2023 - Joshua Ramjist, CAPS - Presentation

Hi everyone, I'm Josh from Sick Kids in Toronto, Canada. I'd like to thank the Stake Current team for the opportunity to present our work in this global forum, as well as the opportunity to represent the Canadian Association of Pediatric Surgeons. This is our five-point enhanced recovery protocol for patients undergoing pex excavatum surgery. I have no relevant disclosure. As this audience knows, pectus excavatum is the most common congenital chest deformity and that it affects one in 400 births. This is a real problem for our patients, as it affects them at a vulnerable time in their lives in the childhood and adolescent years. We are all familiar with the nut procedure, and we know that it's been revolutionary in correcting this deformity. However, despite an excellent operation, the post-operative period has been plagued by pain and subsequentus, and that's resulted in a significant morbidity and an increased length of stay. We designed a five-point s protocol to span the entirety of our patient's perioperative experience. This includes perioperative education and counseling. This established reasonable expectations for care using our educational materials, as well as introducing a boarding pass for our patients and their families. We utilized our transitional pain service to facilitate both pharmacologic and non-pharma interventions to manage patient's pain. We utilized multimodal analgesia intraoperatively in the form of a serratus anterior block as well as cryoablation at the time of procedure. And finally, no general surgery project is complete without thinking about the bowel. So a perioperative bowel regimen was included. All families participating in our program received a boarding pass in preparation for surgery. This boarding pass established the expectations for patients and their families at each phase of care. It was one of the primary instruments to facilitate shared decision making and establish a therapeutic relationship between our team of specialists and the patients. You'll note that in each phase of care, we spend all five interventions. This is a single institution study at the Hospital for Sick Children with retrospective data for the pre-s cohort and prospective data after the implementation in. We recruited 53 patients from August 2015 to December 2021. All patients were similar, at approximately 15 years of age at the time of repair, with Haller indices typically above 4.5. Globally, we maintained compliance with each of the elements within the s bundle. And 92% of our patients expressed satisfaction with their overall experience. As we dive deeper into our results, pictured here in caps purple and red, we see a significant decrease in the length of stay by 50%. From 4 days to just under two days. Looking at the study's run chart in greater detail, when read from left to right, we see a steady decline with each intervention, and this culminated in a mean length of stay of 1.8 days. To put this in real terms, the majority of our patients were leaving on post-operative day one. Finally, when we look at opioid consumption in the post-operative period on days 0, 1 and overall, we see a significant decrease from 6.36 to 3.12 morphine milli equivalence. So while our study utilized a five-point s protocol for patients undergoing pectus repair, our underlying message is that surgery remains a team sport. Successful surgical outcomes are predicated on a multi-disciplinary team working in each phase of care to optimize the patient's experience. And in doing so, we were able to reduce the length of stay as well as opioid consumption within our patient population.