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The effect of an enhanced recovery protocol in pediatric patients who undergo colostomy closure and Malone procedures

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Abstract

Purpose

Pediatric colorectal studies have shown enhanced recovery after surgery (ERAS) protocols can safely improve outcomes. This study sought to determine the impact of an ERAS pathway on the outcomes of children with colorectal conditions who underwent colostomy closure or Malone procedure.

Methods

A single-institution, retrospective cohort study of children who underwent colostomy closure or Malone procedure between 2016 and 2020 was performed. Differences in outcomes between pre-ERAS and ERAS cohorts were tested. A sub-analysis based on procedure type was performed.

Results

There were 96 patients included: 22 prior to ERAS implementation and 74 after. Patients who underwent ERAS had shorter mean time (hours) to oral intake, mean days until regular diet, post-operative opioid volume, and median length of stay (p < 0.05). There was no difference in complication rates in the ERAS and pre-ERAS cohort (12.2 vs 9.1%, p = 0.99). Patients who underwent colostomy closure after ERAS had lower post-operative opioid use, but no differences were seen in those who underwent Malone.

Conclusion

Implementation of an ERAS protocol resulted in quicker time to oral intake, normal diet, and decreased opioid use without increasing complication rates. Differences seen based on procedure type may reflect that the effect of an ERAS protocol is procedure specific.

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Funding

The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Anschutz Medical Campus, Children’s Hospital Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA

    Marina L. Reppucci, Lea A. Wehrli, Julie Schletker, Margo M. Nolan, Jill Ketzer, Alberto Pena, Luis de la Torre & Andrea Bischoff

  2. Research in Outcomes in Children’s Surgery, Children’s Hospital Colorado, Aurora, CO, USA

    Jared Rieck & Souha Fares

  3. Department of Pediatric Urology, Children’s Hospital Colorado, Aurora, CO, USA

    Kyle Rove

Authors
  1. Marina L. Reppucci
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  2. Lea A. Wehrli
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  3. Julie Schletker
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  4. Margo M. Nolan
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  5. Jared Rieck
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  6. Souha Fares
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  7. Jill Ketzer
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  8. Kyle Rove
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  9. Alberto Pena
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  10. Luis de la Torre
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  11. Andrea Bischoff
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Contributions

MLR, JK, KR, AB were responsible for study design. MLR and MNM was responsible for data collection. JR and SF were responsible for data analysis. MLR, LAW, and wrote the main manuscript text. All authors reviewed the manuscript.

Corresponding author

Correspondence to Andrea Bischoff.

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The authors declare no competing interests.

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Reppucci, M.L., Wehrli, L.A., Schletker, J. et al. The effect of an enhanced recovery protocol in pediatric patients who undergo colostomy closure and Malone procedures. Pediatr Surg Int 38, 1701–1707 (2022). https://doi.org/10.1007/s00383-022-05213-z

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