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Feasibility of Enhanced Recovery Protocols in Children

Puett, Lisa, L., BSN, RN; Smith, Laurie, BSN, RN

Journal of Pediatric Surgical Nursing: January/March 2018 - Volume 7 - Issue 1 - p 9–19
doi: 10.1097/JPS.0000000000000159
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Introduction Enhanced recovery after surgery (ERAS) programs have been utilized among various adult populations, and successful outcomes are well described in the literature. However, similar programs are not well established for children. The aims of this article were to explore the existing literature for current knowledge of the feasibility of enhanced recovery protocols in children, to explore patient and provider experiences with enhanced recovery programs, and to discuss implications for nursing.

Methods Two basic searches were conducted using PubMed/Medline, CINAHL, and EMBASE to identify pediatric ERAS studies and studies discussing patient and nurse experiences with ERAS programs. Keywords included “pediatrics or children,” “enhanced recovery after surgery,” “enhanced recovery,” “fast-track surgery,” “ERAS,” “perioperative,” and “experiences/perceptions/attitudes/views/opinions/feelings.”

Results The search for pediatric ERAS studies yielded nine studies: five prospective implementations, one retrospective case-match, one retrospective review, one systematic review, one scoping review, and no randomized control studies. There were different combinations of ERAS principles among the studies, ranging from 5 to 12. Outcomes included a decreased hospital length of stay and reduced time to oral nutrition, return of bowel function, and mobilization. The search for experiences with ERAS yielded three qualitative studies and one systematic review: two patient experience and two healthcare provider experience studies.

Discussion The literature suggests that ERAS protocols in pediatric surgery can be safely integrated into practice and are an effective method for standardizing care. However, additional high-quality experimental and quasi-experimental studies are needed to analyze the impact of ERAS on pediatric patients.

Lisa L. Puett, BSN, RN Pediatric Trauma & Burn Coordinator, Division of Pediatric Surgery, The Johns Hopkins Children's Center, Baltimore, MD.

Laurie Smith, BSN, RN Surgical Clinical Nurse Reviewer, ACS NSQIP–Pediatric, Division of Pediatric Surgery, The Johns Hopkins Children's Center, Baltimore, MD.

The authors have declared no conflict of interest.

Correspondence: Lisa L. Puett, BSN, RN, Division of Pediatric Surgery, The Johns Hopkins Children's Center, 1800 Orleans Street, Suite 7329, Baltimore, MD 21287. E-mail: LSKILES1@JHMI.EDU

Copyright © 2018 American Pediatric Surgical Nursing Association
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