P0958 - Decreased Intravenous Fluid Administration is Associated with Decreased Length of Stay in Pediatric Colorectal Enhanced Recovery after Surgery Patients

Introduction: Adult enhanced recovery after surgery (ERAS) pathways for colorectal surgery are known to reduce postoperative complications, readmissions, and length of stay. The effect of goal-directed fluid therapy (GDFT) has not been studied within pediatric colorectal ERAS pathway implementation.

Methods: A single institution, retrospective cohort study was performed on pediatric patients (≤18 years) undergoing colorectal surgery pre- and post-implementation of an ERAS pathway from 2014–2018. ERAS implementation included intraoperative and postoperative GDFT standardization. Bivariate analysis was conducted over the pre- and post-implementation ERAS cohorts.

Results: Of the 139 patients included, 98 (70.5%) and 41 (29.5%) were managed with and without ERAS pathways, respectively. There was no statistical difference in age, sex, or diagnosis between cohorts. With implementation of GDFT, there was a reduction in the median intraoperative (11.0 ml/kg/hr, IQR: 8.4–14.4 vs. 9.1 ml/kg/hr, IQR: 6.5–12.0, p=0.008, Table 1) and postoperative intravenous fluid volumes (1.5 ml/kg/hr, IQR: 0.6–1.7 vs. 0.9 ml/kg/hr, IQR: 0.4–1.6, p=0.001). The ERAS patient cohort experienced a significant reduction in length of stay without an increased risk of 30-day complications. An increase in the postoperative intravenous fluid (1.0 mL/kg/hr) was associated with a 43.5 hour increased length of stay (95% CI 18.1–69.0, p=0.001) on linear regression analysis when controlling for pertinent factors.

Discussion: Implementation of a pediatric ERAS pathway resulted in the reduction in intraoperative and postoperative crystalloid intravenous fluid volume, which in turn reduced total hospital fluid given. A reduction in the total postoperative fluid was associated with a decrease in hospital length of stay, with no difference in complication rates, supporting the use of GDFT in pediatric ERAS populations. We proffer that GDFT results in an early return of homeostasis by avoiding the untoward effects of hypo- or hypervolemia and may account for our findings.