70 - THE EFFECT OF THE ENHANCED RECOVERY AFTER SURGERY PROTOCOL ON PEDIATRIC SURGICAL PATIENT OUTCOME AT THE UNIVERSITY OF NORTH CAROLINA CHILDREN'S HOSPITAL

Objectives: Enhanced recovery after surgery (ERAS) protocols have been associated with improved clinical outcomes and fewer postoperative complications in adult patients, particularly in colorectal surgery. There is a paucity of data on how these protocols influence outcomes for pediatric patients. Our aim is to describe the effect of ERAS protocols, compared to conventional care, on pediatric colorectal surgery patients.

Methods: We performed a single institution, retrospective cohort study (2014-2020) on pediatric (≤18 years old) colorectal surgery patients pre- and post-implementation of an ERAS protocol. Bivariate analysis and logistic regression were used to assess the effect of ERAS implementation on return visits to the ER, reoperation, and readmission within 30 days.

Results: There were 194 patients included in this study, with 54 in the pre-implementation group and 140 in the post-implementation group. There was no significant difference in the age, BMI, primary diagnosis, or use of laparoscopic technique between the two cohorts. Patients in the ERAS group were more likely to receive a nerve block (19.3% vs. 7.4%, p=0.04) and fewer perioperative opioids (0.7 vs 2.0 MME, p< 0.001). Patients in the control group received more fluids postoperatively (5487.8mL vs. 2250.3mL, p< 0.001), had a foley longer (1.9 vs 1.0 days, p< 0.001), and longer postoperative length of stay (5.87 days vs. 4.15 days, p< 0.001). On bivariate analysis, the ERAS cohort had similar returns to the ER (n=17 (12.1%) vs n=10 (18.5%), p=0.25), readmissions (n=24 (17.1%) vs n=12 (22.2%), p=0.42), and reoperations (n=5 (3.6%) vs n=0 (0%), p=0.18), and any complication (n=36 (25.7%) vs n=15 (27.8%), p=0.77) within 30 days compared to the pre-implementation cohort. After controlling for pertinent covariates, the ERAS cohort experienced higher odds of any complication (OR 1.16, 95% CI 0.40, 3.33, p=0.004) and reoperation within 30 days (OR 130.3, 95% CI 3.88, 4379.02, p-value < 0.001). There was no difference in the odds of readmission (OR 0.90, 95% CI 0.29, 2.79, p=0.90) or return visits to the ER within 30 days (OR 0.57, 95% CI 0.15, 2.10, p-value 0.3435) between the cohorts (Table 1).

Conclusion: In this cohort, there was no difference in the odds of readmission or return to the ER within 30-days of surgery. However, although infrequent, there were higher odds of returns to the OR within 30-days after implementation of an ERAS pathway. Future studies are needed to ensure the safety of these pathways in children, specifically analyzing how adherence to individual components of ERAS influences outcomes.