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Baseline assessment of enhanced recovery after pediatric surgery in mainland China

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Abstract

Background

Enhanced recovery after surgery (ERAS) is a clinical pathway that optimizes perioperative management based on evidence-based medicine. ERAS has been gradually introduced to pediatric surgery in recent years. However, there are limited reports on its overall implementation. We aimed to determine the implementation of ERAS in patients who received pediatric surgery in mainland China.

Methods

We designed a questionnaire involving 17 key ERAS elements and sent the questionnaire to 66 chiefs of pediatric surgery distributed throughout 31 provinces in mainland China to obtain a baseline assessment of the assimilation of ERAS protocols in the care of congenital biliary dilatation (CBD).

Results

A total of 66 questionnaires were collected. The range of elements implemented at participating centers was 4–16, with a mean of 10.23. The least commonly practiced elements were administration of non-opioid preoperative analgesia (6 centers, 9.09%), prevention of postoperative nausea and vomiting [PONV] (9 centers, 13.64%), and postoperative pain management (26 centers, 39.39%).

Conclusions

The implementation of elements differed from center to center. Measures relying primarily on anesthesiologists had lower execution. The adherence to ERAS elements was often inhibited by a lack of institutional support, poor knowledge of ERAS protocols, and difficulties in coordinating multidisciplinary care, as well intransigence in changing surgical practices out of fear of liability for poor outcomes.

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Data availability

The original data analysed during this current study are available from the corresponding author Weibing Tang (twbcn@163.com) on reasonable request.

Abbreviations

CBD:

Congenital biliary dilatation

CCC:

Congenital choledochal cyst

ERAS:

Enhanced recovery after surgery

LOS:

Length of stay

NSQIP:

National Surgical Quality Improvement Program

PONV:

Postoperative nausea and vomiting

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Acknowledgements

The authors thank all respondents who participated in this survey and professionals who offered help.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Nan **e and Hua **e have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Pediatric Surgery, Children’s Hospital of Nan**g Medical University, 72 Guangzhou Road, Nan**g, 210000, Jiangsu Province, China

    Nan **e, Hua **e & Weibing Tang

Authors
  1. Nan **e
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Contributions

WT: conceptualization, methodology, supervision; NX: software, formal analysis, investigation, data curation, writing—original draft, visualization; HX: visualization, writing—review and editing, project administration. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Weibing Tang.

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The authors declare no conflict of interest.

Ethical approval

Informed consent was obtained from all individual participants included in the study. The study was approved by the Ethics Committee of Nan**g Children's Hospital affiliated to Nan**g Medical University.

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**e, N., **e, H. & Tang, W. Baseline assessment of enhanced recovery after pediatric surgery in mainland China. Pediatr Surg Int 39, 32 (2023). https://doi.org/10.1007/s00383-022-05315-8

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