Wharton Kristin, Chun Young, Hunsberger Joann, Jelin Eric, Garcia Alejandro, Stewart Dylan
Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg Center 7311, Baltimore, MD 21287.
Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg Center 6321, Baltimore, MD 21287.
J Pediatr Surg. 2020 Jun;55(6):1065-1071. doi: 10.1016/j.jpedsurg.2020.02.049. Epub 2020 Mar 3.
Pectus excavatum is a common chest wall deformity amenable to surgical correction, most commonly by a technique known as the Nuss Procedure. The surgery is associated with significant postoperative pain and lengthy hospital stays. We hypothesized that a standardized enhanced recovery after surgery (ERAS) pathway would result in significantly reduced length of stay (LOS) and reduced levels of postoperative pain without an increase in readmissions or emergency department (ED) visits.
We instituted a pectus excavatum ERAS program at a high-volume academic center. Our ERAS protocol standardized perioperative exercise and pharmacologic regimens, pre- and post-operative education, and early return to activity. We conducted a retrospective review of all patients undergoing the Nuss procedure from 2015 to 2018. ERAS was implemented at the mid-point of the study period, and pre- and post-protocol patients were compared in our analysis. The primary outcome measure was LOS. The secondary outcomes included pain scores, incidence of urinary retention, and readmissions or ED visits.
One hundred nine patients were included in this study (51 patients pre-ERAS and 58 post-ERAS). The average length of hospitalization prior to implementation of ERAS was 3.49 and after the implementation 2.90 (p = 0.0007). The implementation of ERAS showed a trend of decreasing readmissions and emergency department visits, but this did not reach statistical significance. There was a statistically significant decrease in both requirement for urinary catheter placement and pain scores on postoperative day 0.
Implementation of ERAS for the Nuss procedure leads to a significant reduction in LOS, early pain scores, and urinary catheter usage, without an increase in post-operative ED visits and hospital readmissions. An ERAS protocol should be utilized in this patient population.
Retrospective comparative study.
Level III.
漏斗胸是一种常见的胸壁畸形，适合手术矫正，最常用的技术是努氏手术。该手术与术后显著疼痛和较长住院时间相关。我们假设标准化的术后加速康复（ERAS）方案将显著缩短住院时间（LOS）并降低术后疼痛程度，且不会增加再入院率或急诊就诊次数。
我们在一家大型学术中心开展了漏斗胸ERAS项目。我们的ERAS方案规范了围手术期运动和药物治疗方案、术前和术后教育以及早期恢复活动。我们对2015年至2018年所有接受努氏手术的患者进行了回顾性研究。ERAS在研究期间的中点实施，在分析中对方案实施前后的患者进行了比较。主要结局指标是住院时间。次要结局包括疼痛评分、尿潴留发生率以及再入院或急诊就诊情况。
本研究纳入了109例患者（ERAS实施前51例，实施后58例）。ERAS实施前的平均住院时间为3.49天，实施后为2.90天（p = 0.0007）。ERAS的实施显示出再入院和急诊就诊次数有下降趋势，但未达到统计学显著性。术后第0天导尿管放置需求和疼痛评分均有统计学显著下降。
努氏手术实施ERAS可显著缩短住院时间、降低早期疼痛评分并减少导尿管使用，且不会增加术后急诊就诊和再入院率。该患者群体应采用ERAS方案。
回顾性比较研究。
三级。
