(837) Application of Enhanced Recovery After Surgery Protocols in Pediatric Critical Care: A Meta-Analysis

Introduction: Enhanced Recovery After Surgery (ERAS) refers to perioperative protocols designed to expedite recovery from surgical intervention by systematic application of evidence-based practices. ERAS protocols are known to improve patient care outcomes in adults, however their use in pediatric populations had not been studied until recently, and is more limited in scope. This systematic review and meta-analysis aims to determine if ERAS protocols are an effective perioperative strategy for children who typically recover from extensive elective surgery in an intensive care unit (ICU).

Methods: A systematic search of PubMed, Web of Science, and Cochrane Libraries for all randomized-control trials and cohort studies pertaining to application of ERAS in children that frequently require ICU admission for post-operative care was performed by three independent reviewers. Studies including posterior spinal fusion, neurosurgical, cardiac, urological reconstruction, and oncologic procedures were included in the analysis. After data extraction, a meta-analysis was performed using Python and R, with a p-value of < 0.05 considered statistically significant.

Results: Sixteen studies with a total of 17,599 participants were included in the meta-analysis. The use of ERAS protocols resulted in significantly decreased hospital length of stay (mean difference: -2.04 days, 95% CI [-3.13, -0.98], p < 0.01), ICU length of stay (mean difference: -0.70 days, 95% CI [-1.40, -0.01], p < 0.01), and return of bowel function (mean difference: -1.88 days, 95% CI [-3.50, -0.25], p < 0.01). There was no significant difference between the ERAS group and control group in terms of complications (p = 0.31), readmission (p = 0.30), or reoperation (p = 0.37). While data was insufficient for definitive conclusions on opioid use and time to ambulation, ERAS protocol application patients tended to have lower values for each.

Conclusions: ERAS is an effective method of reducing hospital and ICU length of stay, with faster return of bowel function in children with extensive surgeries frequently requiring planned ICU admission, while not impacting the number of complications, readmissions, or reoperations. The use of ERAS protocols may decrease opioid use and time to ambulation. ERAS protocols hold promise in expediting recovery in children.