Feasibility of Fast-Track Elements in Pediatric Surgery

Reismann, Marc; Arar, Morsi; Hofmann, Alejandro D.; Schukfeh, Nagoud; Ure, Benno M.

doi:10.1055/s-0031-1284422

Cited by 53 publications

(42 citation statements)

References 16 publications

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“…[3][4][5][6] It was shown in several prospective studies that fast-track concepts can also be safely applied in children undergoing routine pediatric surgery. [7][8][9] Fast-track treatment was successful in more than one-third of our patients and patient/parent satisfaction was excellent. 8 It took several years to develop, modify, and finally establish fast-track concepts in an academic institution with its large capacities.…”

Section: Introductionmentioning

confidence: 70%

“…Fast-track concepts were implemented according to the "Hannover criteria" and guidelines which were published previously by our group. [7][8][9] Briefly, these included instructions for patients/parents, clinical pathways, and concepts for perioperative care and follow-up. Drains, tubes, and catheters were avoided whenever possible and minimally invasive techniques were routinely used.…”

Section: Methodsmentioning

confidence: 99%

“…Drains, tubes, and catheters were avoided whenever possible and minimally invasive techniques were routinely used. [12][13][14][15] The following six types of procedures were initially selected similar to previous studies [7][8][9] : appendectomy, hypospadias repair, fundoplication, pyloromyotomy, pyeloplasty, and hemi/nephrectomy. Groups with less than five operations during the study period were excluded from the final analysis.…”

Section: Methodsmentioning

confidence: 99%

“…This questionnaire has been previously validated. [7][8][9] For this purpose, a modified version of the patient evaluation in the perioperative phase (PPP33) questionnaire comprising questions on patient information, convalescence, and complaints was used. 20,21 Parents rated satisfaction with fast-track surgery on a 10-point scale (1 ¼ not satisfied, 10 ¼ very satisfied).…”

Section: Methodsmentioning

confidence: 99%

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Implementation of Fast-Track Pediatric Surgery in a German Nonacademic Institution without Previous Fast-Track Experience

et al. 2013

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Fast-track concepts in pediatric surgery were established in a university hospital in consecutive studies within several years. They significantly reduced the length of hospitalization compared with German institutions without fast-track protocols. The aim of this study was to assess the implementation process of fast-track in a German nonacademic department of pediatric surgery without previous fast-track experience. All patients undergoing four types of operations (appendectomy, hypospadias repair, pyloromyotomy, and fundoplication) from February 2011 to January 2012 were included in this prospective study. Fast-track included detailed clinical pathways and specific pain treatment protocols using validated pain scales according to age. Mobilization and oral nutrition were started 2 hours postoperatively and documented with established scores. The length of hospital stay was compared with data from other hospitals with conventional treatment using information from the German reimbursement system (German diagnosis-related groups [G-DRG]) and with the hospital stay of patients from the corresponding university hospital undergoing fast-track treatment for the same procedures during the same study period. Two weeks after discharge, a questionnaire was completed by the patients/parents. A total of 143 patients with a mean age of 7.9 ± 5.0 years underwent fast-track treatment. The mean pain intensity during the immediate postoperative period was 1.7 ± 2.1 in patients < 4 years and 2.3 ± 2.1 in patients ≥ 4 years on a 10-point scale. Full mobilization was reached after a mean duration of 2.3 ± 2.0 days while full oral nutrition was completed after a mean duration of 1.8 ± 1.4 days. There were no complications associated with fast-track. The mean hospital stay was 5.8 ± 3.4 days which was not significantly different compared with G-DRG data from other hospitals without fast-track. This was in contrast to the mean hospital stay of patients from the corresponding university hospital (5.6 ± 3.0 days vs. G-DRG 6.9 ± 3.2 days, p < 0.05). After 2 weeks, patients/parents were highly satisfied with fast-track (mean score of 8.6 ± 1.4 on a 1-10-point scale) and 95.2% claimed that they would choose it again. Fast-track concepts can be applied in a nonacademic department of pediatric surgery without previous fast-track experience and with excellent patient/parent satisfaction. However, the G-DRG system interferes with concepts of early discharge of patients. Modifications of the reimbursement modalities within the German health care system seem to be mandatory.

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Section: Introductionmentioning

confidence: 70%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Implementation of Fast-Track Pediatric Surgery in a German Nonacademic Institution without Previous Fast-Track Experience

et al. 2013

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“…ERAS ® or ERAS ® -like guidelines have been developed within a number of pediatric specialties and many traditional ERAS elements have been adopted from adult guidelines especially for adolescents. The majority of these guidelines have been created specifically for single sites [26,27]. Following a multi-disciplinary American Academy of Pediatrics symposium in 2017, a multi-center working group was organized by Raval et al and has taken a broader view, created a colorectal guideline designed for staggered adoption at 18 sites across the United States [12].…”

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confidence: 99%

Embracing change: the era for pediatric ERAS is here

et al. 2019

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The concept of Enhanced Recovery After Surgery (ERAS) has increasingly been embraced by our adult surgical colleagues, but has been slow to crossover to pediatric surgical subspecialties. ERAS ® improves outcomes through multiple, incremental steps that act synergistically throughout the entire surgical journey. In practice, ERAS ® is a strategy of perioperative management that is defined by strong implementation and ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. There are increasing numbers of surgical teams exploring ERAS ® in children and there is mounting evidence that this approach may improve surgical care for children across the globe. The first World Congress in Pediatric ERAS ® in 2018 has set the stage for a new era in pediatric surgical safety.

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