为在儿科人群中实施而准备术后加速康复。
Preparing enhanced recovery after surgery for implementation in pediatric populations.
作者信息
Leeds Ira L, Boss Emily F, George Jessica A, Strockbine Valerie, Wick Elizabeth C, Jelin Eric B
机构信息
Department of Surgery, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287.
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.
出版信息
J Pediatr Surg. 2016 Dec;51(12):2126-2129. doi: 10.1016/j.jpedsurg.2016.08.029. Epub 2016 Sep 5.
UNLABELLED
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.
LEVEL OF EVIDENCE
Level 5.
未标注
在过去二十年中，围手术期护理的标准化已使手术结果有了重大改善。术后加速康复（ERAS）计划是影响手术结果和护理效率的临床路径的一个例子，但这些计划尚未广泛应用于儿童手术。在成人中，ERAS路径已被证明可缩短住院时间、降低并发症发生率并提高患者满意度。这些路径通过对现有循证最佳实践进行标准化来改善结果。目前，将ERAS路径应用于小儿外科手术患者的直接证据有限。在儿童中实施ERAS计划面临的挑战包括成人证据缺乏直接可转化性，以及小儿医疗服务提供者和患者家庭对ERAS原则的接受程度各不相同。我们描述了在直接证据有限的时代，我们新实施的针对小儿结直肠手术患者的ERAS计划，并讨论了为更广泛地实施小儿ERAS路径还需要解决哪些进一步的问题。
证据水平
5级。
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