Utilization of Enhanced Recovery After Surgery (ERAS) protocol in pediatric laparoscopic sleeve gastrectomy: a quality improvement project

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...

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Bibliographic Details
Published in:Pediatric surgery international 2024-11, Vol.40 (1), p.297, Article 297
Main Authors: Fall, Fari, Pace, Devon, Brothers, Julia, Jaszczyszyn, Danielle, Gong, Julia, Purohit, Manish, Sadacharam, Kesavan, Lang, Robert S., Berman, Loren, Lin, Connie, Reichard, Kirk
Format: Article
Language:English
Subjects:
Adolescent
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Child
Clinical Protocols
Enhanced Recovery After Surgery
Female
Gastrectomy - methods
Gastrointestinal surgery
Humans
Laparoscopy
Laparoscopy - methods
Length of Stay - statistics & numerical data
Lidocaine - administration & dosage
Male
Medicine
Medicine & Public Health
Narcotics
Obesity, Morbid - surgery
Original Article
Pain, Postoperative - drug therapy
Pain, Postoperative - prevention & control
Pediatric Obesity - surgery
Pediatric Surgery
Pediatrics
Quality Improvement
Recovery (Medical)
Retrospective Studies
Surgery
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Summary: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  
ISSN:1437-9813
0179-0358
1437-9813
DOI:10.1007/s00383-024-05874-y