Department of Colorectal Surgery, Royal Liverpool and Broadgreen University Teaching Hospitals, Liverpool, Merseyside, UK.
J Pediatr Surg. 2013 Sep;48(9):1924-30. doi: 10.1016/j.jpedsurg.2013.02.063.
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).
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.
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.
Potentially, application of ERAS in paediatric surgery could accelerate recovery and reduce length of post-operative stay thereby improving quality and efficiency of care.
优化围手术期护理的结构化护理路径已被证明能显著促进术后恢复。我们旨在确定是否可以为因炎症性肠病（IBD）而接受主要结直肠切除术的儿科患者提供术后快速康复（ERAS）方案的获益。
采用标准围手术期护理方法，对在区域性儿科病房接受择期肠道切除术治疗 IBD 的儿童进行研究，并与已使用 ERAS 方案的关联三级转诊大学医院的成人病例相匹配。病例按照疾病类型、性别、手术程序和 ASA 分级进行匹配。
共确定了 44 名儿童进行了 50 次手术。34 例与成人病例相匹配。儿科组的总住院时间明显长于成人组（6 天与 9 天；P=0.001）。儿科患者开始固体饮食的时间更慢（1 天与 4 天；P<0.0001），术后开始活动的时间也更慢（1 天与 4 天；P<0.0001）。肠道功能恢复时间无差异（2 天与 3 天；P=0.49）。两组之间 30 天再入院率和总住院期间发病率无显著差异。
在小儿外科中应用 ERAS 方案可能会加速康复并缩短术后住院时间，从而提高护理质量和效率。
