Enhanced recovery care versus traditional non-ERAS care following osteotomies in developmental dysplasia of the hip in children: a retrospective case-cohort study

Abstract

Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopaedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0 ± 3.1 in the traditional care group to 6.0 ± 0.8 days in the ERAS(P < 0.001). The average VAS score in the first 3 days was significantly lower in the ERAS group (2.9 ± 0.8) than the traditional non-ERAS group (4.0 ± 0.8) (P < 0.001). However, there was no significant difference in the frequency of break-out pain (VAS > 4) between two groups (29.5 ± 6.3 times vs.30.6 ± 6.5 times, P = 0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

Enhanced Recovery after Surgery Rehabilitation Protocol in the Perioperative Period of Orthopedics: A Systematic Review

“…Of these articles, 11 are for fracture-related procedures [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. There are 14 articles on joint replacement-related surgery [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] and 15 articles on spine surgery [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. The relevant literature search and exclusion process is shown in Figure 1 .…”

“… ( A ): Risk of bias assessment in studies. ( B ): Risk of bias assessment in each study [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. …”

“…( B ): The forest plot for joint replacement surgery of length of hospitalization. ( C ):The forest plot for spine surgery of length of hospitalization [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

Evaluation of open reduction of distal humerus fractures in children after implementation of an enhanced recovery after surgery program

“…Reducing the hospitalization time of pediatric patients has always been one of the ERAS goals. Many retrospective studies and related meta-analyses at home and abroad have indicated that the ERAS protocol can strikingly shorten the length of hospital stay of pediatric patients [ 11 , 12 ]; however, these studies have mostly focused on abdominal surgery, and evidence from RCTs is lacking. The present work unveiled that the ERAS program shortened the postoperative hospital stay of pediatric patients by approximately 1 day, but it did not significantly shorten the total hospital stay, likely relating to the generally mild disease, fast recovery, short hospitalization time in children with distal humerus fractures.…”

The implementation of a pectus bar insertion enhanced recovery after surgery pathway: A quality improvement initiative

“…All ERAS pathways aim to optimize perioperative care through protocols based on the best scientific evidence available. 12 This reduces the length of hospital stay, decreases the incidence of complications, and promotes rehabilitation. 13 ERAS pathways were initially developed for the adult population, and the ERAS society has since published several surgery-specific guidelines for the adult population that are now standards of care based on robust scientific evidence, but there is far less literature available for the pediatric population.…”