Preparing enhanced recovery after surgery for implementation in pediatric populations.
Standardization in perioperative care has led to major improvements in surgical outcomes during the last two decades. Enhanced recovery after surgery (ERAS) programs are one example of a clinical pathway impacting both surgical outcomes and efficiency of care, but these programs have not yet been widely adapted for surgery in children. In adults, ERAS pathways have been shown to reduce length of stay, reduce complication rates, and improve patient satisfaction. These pathways improve outcomes through standardization of existing evidence-based best practices. Currently, the direct evidence for adapting ERAS pathways to pediatric surgery patients is limited. Challenges for implementation of ERAS programs for children include lack of direct translatability of adult evidence as well as varying levels acceptability of ERAS principles among pediatric providers and patients' families. We describe our newly implemented ERAS program for pediatric colorectal surgery patients in an era of limited direct evidence and discuss what further issues need to be addressed for broader implementation of pediatric ERAS pathways.


METHODS
Level 5.
Department of Surgery, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287.
Ira L
IL
Leeds
Department of Otolaryngology-Head and Neck Surgery and Health Policy & Management, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287.
Emily F
EF
Boss
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Children's Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287.
Jessica A
JA
George
Department of Surgery, Johns Hopkins Bloomberg Children's Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg 7323, Baltimore, MD 21287.
Valerie
V
Strockbine
Department of Surgery, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287.
Elizabeth C
EC
Wick
Department of Surgery, Johns Hopkins Bloomberg Children's Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg 7323, Baltimore, MD 21287. Electronic address: ejelin1@jhmi.edu.
Eric B
EB
Jelin
D002648:Child; D019091:Critical Pathways / Q000458:organization & administration*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D019990:Perioperative Care / Q000592:standards*
Enhanced recovery after surgery; Eras; Implementation; Pediatric; Surgery
Pediatr Crit Care Med. 2014 Feb;15(2):131-8
24366508
Curr Opin Anaesthesiol. 2004 Jun;17(3):229-34
17021556
Paediatr Anaesth. 2014 Jun;24(6):553-60
24612266
J Pediatr Surg. 2016 Jun;51(6):970-4
27018086
Ann Surg. 2015 Dec;262(6):1026-33
25371130
Anaesthesia. 1998 May;53(5):424-30
9659013
JAMA Surg. 2014 Aug;149(8):863-8
25006700
World J Surg. 2014 Jun;38(6):1531-41
24368573
Colorectal Dis. 2012 Sep;14(9):1045-51
21985180
J Surg Res. 2016 May 1;202(1):165-76
27083963
Br J Surg. 2014 Feb;101(3):172-88
24469618
J Am Coll Surg. 2011 Jan;212(1):1-11
21036076
Langenbecks Arch Surg. 2009 May;394(3):529-33
19050911
J Pediatr Surg. 2014 Jun;49(6):1020-4; discussion 1024-5
24888855
Dis Colon Rectum. 2013 May;56(5):667-78
23575408
J Pediatr Surg. 2013 Sep;48(9):1924-30
24074669
JAMA Pediatr. 2016 Jun 1;170(6):570-6
27088649
Pediatr Crit Care Med. 2004 Nov;5(6):539-41
15530189
J Pediatr Surg. 2015 Jan;50(1):192-200
25598122
Qual Saf Health Care. 2006 Apr;15(2):89-91
16585106
Ann Surg. 2014 Apr;259(4):670-6
23673770
JAMA Surg. 2014 Oct;149(10):1053
25162744
J Pediatr Surg. 2014 Jan;49(1):129-32; discussion 132
24439596