Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
J Surg Res. 2023 Mar;283:313-323. doi: 10.1016/j.jss.2022.10.018. Epub 2022 Nov 21.
Surgical repair of pectus excavatum and carinatum in children has historically been associated with severe postoperative pain and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, multimodal approach designed to fast-track surgical care. However, obstacles to implementation have led to very few within pediatric surgery. The aim of this study is to outline the process of development and implementation of an ERAS protocol for pectus surgical repair using fundamental principles of implementation science.
A multidisciplinary team of providers worked collaboratively to develop an ERAS protocol for surgical repair of pectus excavatum and carinatum and methods for identifying eligible patients. The surgical champion collaborated with all end users to review and revise the ERAS protocol, assessing all foreseeable barriers and facilitators prior to implementation.
Our entire pediatric surgery team, nurses at every stage (clinic/preoperative/recovery/floor), physical therapy, and information technology contributed to the creation and implementation of an ERAS protocol with seven phases of care. The finalized version was implemented by end users focusing on four main areas: pain control, ambulation, diet, and education. Barriers and facilitators were continually addressed with an iterative process to improve the success of implementation.
This is one of the first studies in children which details the step-by-step process of developing and implementing an ERAS protocol for pectus excavatum and carinatum. The process of development and implementation of an ERAS protocol as outlined in this manuscript can serve as a model for future ERAS protocols in pediatric surgery.
在儿童中，胸壁凹陷和鸡胸的手术修复历来与严重的术后疼痛和延长住院时间相关。加速康复外科（ERAS）是一种多学科、多模式的方法，旨在加快外科护理。然而，实施过程中的障碍导致在小儿外科中非常少见。本研究旨在概述使用实施科学的基本原则制定和实施胸壁手术修复 ERAS 方案的过程。
一个多学科的提供者团队合作制定了一个用于胸壁凹陷和鸡胸手术修复的 ERAS 方案，以及识别合格患者的方法。手术冠军与所有最终用户合作，审查和修改 ERAS 方案，在实施前评估所有可预见的障碍和促进因素。
我们的整个小儿外科团队、每个阶段（诊所/术前/恢复/病房）的护士、物理治疗师和信息技术都为创建和实施 ERAS 方案做出了贡献，该方案有七个护理阶段。最终版本由最终用户实施，重点关注四个主要领域：疼痛控制、活动、饮食和教育。通过迭代过程不断解决障碍和促进因素，以提高实施的成功率。
这是在儿童中详细描述开发和实施胸壁凹陷和鸡胸 ERAS 方案的逐步过程的首批研究之一之一。本文概述的 ERAS 方案的开发和实施过程可以作为小儿外科未来 ERAS 方案的模型。
