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Enhanced Recovery After Surgery in Pediatric and Adolescent Gynecology: A Pilot Study.
Journal of Pediatric and Adolescent Gynecology ( IF 1.8 ) Pub Date : 2020-02-12 , DOI: 10.1016/j.jpag.2020.02.001
Abigail E Smith 1 , Kurt Heiss 2 , Krista J Childress 3
Affiliation  

Study Objective

Enhanced recovery after surgery (ERAS) protocols have been successfully implemented in adult gynecology as well as adult and pediatric colorectal and urologic surgery with reduction in narcotic use, complications, return to the system (RTS), length of stay (LOS), and improved patient satisfaction. There are no studies evaluating the use of ERAS in pediatric and adolescent gynecology (PAG). The goals of this study are to present initial patient outcomes using ERAS in PAG patients undergoing intra-abdominal gynecologic surgery to prove efficacy, patient satisfaction, and decreased narcotic use.

Design

As a quality improvement measure in perioperative care, an ERAS protocol including preoperative, intraoperative, and postoperative components and a follow-up patient telephone call for pain assessment was implemented for all intra-abdominal gynecologic procedures. A retrospective study on implementation of ERAS components, outcomes, and patient satisfaction was then performed in participants meeting inclusion criteria.

Setting

Large academic children's hospital.

Participants

Patients <25 years of age who underwent laparoscopic (LSC) or open abdominal (XLAP) gynecologic surgery using an ERAS protocol by the PAG service over a 12-month period.

Interventions

An ERAS protocol including preoperative, intraoperative, and postoperative components and follow-up patient telephone call for pain assessment was implemented for all major gynecologic surgeries performed by the PAG service.

Main Outcome Measures

Patient satisfaction with the perioperative ERAS protocol along with components including pain management, narcotic use, LOS, RTS, and postoperative complications for various intra-abdominal gynecologic procedures.

Results

A total of 40 participants met inclusion criteria for the study. Thirty-four (85%) participants underwent LSC procedures and six (15%) underwent XLAP. Of the LSC patients, 95% were discharged on postoperative day 0, and all XLAP patients and one LSC patient were discharged on postoperative day 1. In all, 95% of patients were discharged from the hospital requiring only non-narcotic ERAS medications. There were no readmissions or postoperative complications. All patients were satisfied with their postoperative pain control at their follow-up telephone call and clinic visit.

Conclusion

Implementation of a pediatric-specific ERAS protocol in children and adolescents undergoing gynecologic surgery is feasible and safe, and leads to less narcotic use without an increase in complications or decrease in patient satisfaction.



中文翻译:

儿科和青少年妇科手术后恢复增强:一项初步研究。

研究目标

在成年妇科以及成年和小儿大肠及泌尿外科手术中已成功实施了增强的术后恢复(ERAS)协议,从而减少了麻醉剂的使用,并发症,返回系统(RTS),住院时间(LOS)并得到了改善病人的满意度。没有研究评估ERAS在儿科和青春期妇科(PAG)中的使用。这项研究的目的是在接受腹部妇科手术的PAG患者中使用ERAS来介绍患者的初步结局,以证明疗效,患者满意度和减少麻醉剂的使用。

设计

作为围手术期护理的质量改进措施,对所有腹腔内妇科手术均实施了ERAS协议,包括术前,术中和术后组件以及随访患者的电话以评估疼痛。然后,对符合纳入标准的参与者进行了有关ERAS组件,结局和患者满意度的实施的回顾性研究。

设置

大型学术儿童医院。

参加者

<25岁的患者,在12个月内使用PAG服务使用ERAS协议进行了腹腔镜(LSC)或开腹(XLAP)妇科手术。

干预措施

对PAG服务执行的所有主要妇科手术均实施了ERAS协议,包括术前,术中和术后成分以及随访患者的电话以评估疼痛。

主要观察指标

患者对围手术期ERAS方案的满意度以及包括疼痛处理,麻醉使用,LOS,RTS以及各种腹部内妇科手术的术后并发症在内的要素。

结果

共有40名参与者符合该研究的纳入标准。三十四名(85%)参与者接受了LSC程序,六名(15%)接受了XLAP。在LSC患者中,术后第0天出院了95%,所有XLAP患者和1位LSC患者在术后第1天出院了。总共,有95%的患者出院仅需要非麻醉性ERAS药物。没有再入院或术后并发症。所有患者在随访电话和诊所就诊时对术后疼痛的控制感到满意。

结论

在接受妇科手术的儿童和青少年中实施儿科专用的ERAS方案是可行且安全的,并且可减少麻醉药的使用,而不会增加并发症或降低患者满意度。

更新日期:2020-02-12
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