title: Enhancing recovery in pediatric surgery: a review of the literature.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS), guidelines entail a strategy of perioperative management proven to hasten postoperative recovery and reduce complications in adult populations. Relatively few studies have investigated the applicability of this paradigm to pediatric populations. Our objective was to perform a systematic review of existing evidence regarding the use and efficacy of enhanced recovery protocols (ERPs) in the pediatric population.
  
  
  METHODS
  Data were collected through a PubMed/MEDLINE literature search. Study eligibility criteria included a pediatric population and implementation of at least four components of published ERAS Society recommendations.
  
  
  RESULTS
  One retrospective and four prospective cohort studies evaluating children undergoing gastrointestinal, urologic, and thoracic surgeries were identified. The overall quality of reporting was fair with few studies acknowledging limitations and bias and inconsistent outcome reporting. Studies included six or fewer interventions compared to 20 recommended interventions in most adult ERAS Society guidelines. None of the studies were well controlled. Nevertheless, these studies suggest that ERPs applied to the appropriate pediatric surgical populations may be associated with decreased length of stay, decreased narcotic use, and no detectable increase in complications.
  
  
  CONCLUSIONS
  There is a paucity of high-quality literature evaluating implementation of ERPs in pediatric populations. The limited literature available indicates that ERPs would be safe and potentially effective. More studies are needed to assess the efficacy of ERPs in pediatric surgery.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Shinnick
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Short
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Kurt F
authors.initials: KF
authors.lastname: Heiss
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Santore
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia. Electronic address: mehulvraval@emory.edu.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
mesh_terms: D002648:Child; D006801:Humans; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control; D058996:Quality Improvement; D013043:Specialties, Surgical
keywords: Enhanced recovery protocols; Fast-track protocols; Pediatric surgery; Quality improvement