Potential benefits of fast-track concepts in paediatric colorectal surgery.
BACKGROUND
Structured care pathways optimising peri-operative care have been shown to significantly enhance post-operative recovery. We aim to determine if enhanced recovery after surgery (ERAS) principles could provide benefit for paediatric patients undergoing major colorectal resection for inflammatory bowel disease (IBD).


METHODS
Children undergoing elective bowel resection for IBD at a regional paediatric unit using standard methods of peri-operative care were matched to adult cases from an associated tertiary referral university hospital already using an ERAS program. Cases were matched for disease type, gender, operative procedure, and ASA grade.


RESULTS
Forty-four children undergoing fifty procedures were identified. Thirty-four were matched to adult cases. Total length of stay in the paediatric group was significantly longer than in the adult group (6 vs. 9 days; P=0.001). Paediatric patients were slower to start solid diet (1 vs. 4 days; P<0.0001) and were slower to mobilize post-operatively (1 vs. 4 days; P<0.0001). No difference was seen in time to restoration of bowel function (2 vs. 3 days; P=0.49). Thirty day readmissions and total in-hospital morbidity were not significantly different between the groups.


CONCLUSIONS
Potentially, application of ERAS in paediatric surgery could accelerate recovery and reduce length of post-operative stay thereby improving quality and efficiency of care.
Department of Colorectal Surgery, Royal Liverpool and Broadgreen University Teaching Hospitals, Liverpool, Merseyside, UK. Electronic address: malcolmwest@nhs.net.
Malcolm A
MA
West
James F
JF
Horwood
Sally
S
Staves
Colin
C
Jones
Michael R
MR
Goulden
Joanne
J
Minford
Graham
G
Lamont
Colin T
CT
Baillie
Paul S
PS
Rooney
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003082:Colectomy / Q000379:methods / Q000534:rehabilitation; D039021:Colonic Pouches; D003107:Colorectal Surgery / Q000534:rehabilitation*; D019091:Critical Pathways; D004032:Diet; D004434:Early Ambulation; D017558:Elective Surgical Procedures / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000534:rehabilitation; D015212:Inflammatory Bowel Diseases / Q000534:rehabilitation / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods / Q000534:rehabilitation; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011229:Preanesthetic Medication; D020127:Recovery of Function; D055815:Young Adult
Enhanced recovery after surgery; Inflammatory bowel disease; Length of hospital stay; Morbidity