P0987 - The Effect of ERAS Pathway Implementation in Pediatric Colorectal Surgery Patients

Introduction: Enhanced Recovery After Surgery (ERAS) pathways have led to major improvements in surgical outcomes over the past two decades. In adults they have improved efficiency of care and decreased length of stay without increasing postoperative complications. The effects of these pathways in pediatric patients is less well known. In this study, we aim to evaluate the effects of ERAS implementation in pediatric patients undergoing colorectal surgery.

Methods: This is a single-institution, retrospective cohort study. The ERAS protocol was introduced in 2017 and patients were divided into pre-ERAS (2014 to 2016) and post-ERAS (2017 to 2019) groups. Patients aged 2 to 22 undergoing colorectal surgery were included. Data was obtained through the electronic medical record using pre-determined CPT codes and patients with an alternative primary diagnosis were excluded. Outcomes of interest were: length of stay, postoperative pain scores and postoperative complications.

Results: 432 patients were included, 148 patients in the pre-ERAS and 284 in the post-ERAS group. There was a significant decrease in length of stay (5.7 vs 8.3 days,p<0.01). This was accompanied by a decrease of intraoperative local anesthetic (9.5% vs 38.5%,p<0.01) due to increased regional anesthetic use, and decreased postoperative opioid use (62.5% vs 98.7%,p<0.01). Importantly, average pain scores improved, seen both on postoperative day one (4.5 vs 3.6,p<0.05) and across the length of stay (4.0 vs 3.0,p<0.01). There was also a decrease in postoperative complications (0.7% vs 10.8%,p<0.01).

Conclusion: While ERAS implementation has been shown to improve outcomes in adults, the evidence for its use in children is scarce. Results from this study demonstrate that ERAS in the pediatric surgery population decreases length of stay, postoperative pain scores, narcotic use and postoperative complications. This suggests that the widespread implementation of ERAS should be considered to improve outcomes and patient care in the pediatric colorectal surgery population.