BOB Ped Surg 2023 - Wendy Jo Svetanoff, IPEG - Presentation

Reports of ERAS protocols in pediatric metabolic and bariatric surgery are limited

In 2018, the institution developed an ERAS protocol for adolescents undergoing robotically assisted vertical sleeve gastrectomy focusing on pain management, nausea control, and early oral intake and ambulation

The study was a single institution retrospective review with pre-post analysis of patients who underwent robotic sleeve gastrectomy from July 2015 to July 2021

The ERAS algorithm was developed as part of a multi-specialty quality improvement project with four main areas of focus: post-operative pain, nausea, narcotic use, and oral fluid intake

Pre-operative management included allowing a carbohydrate electrolyte drink on day of surgery, along with pre-operative pain and nausea medication

Intraoperatively, ketorolac and bilateral TAP blocks were given for pain control, while metoclopramide and dexamethasone were given for nausea management

Post-operatively, a multimodal non-narcotic pain regimen was scheduled, while narcotic pain medication was available on an as needed basis

Patients were discharged after demonstrating tolerance of a bariatric phase one diet without nausea or vomiting and had good pain control with oral medications only

110 patients were included in the analysis, with 60 patients in the pre-ERAS group and 50 patients in the post-ERAS group

There was a significantly higher percentage of females in the pre-ERAS group, while all other demographic characteristics were similar between the two groups

No difference was noted in operating time or total OR time between groups

Significantly more patients in the post-ERAS group received intraoperative acetaminophen and ketorolac

Patients in the post-ERAS group received significantly fewer opioid medications

The median time to first oral intake was 1.5 hours sooner in the post-ERAS group

The time to first ambulation was 1 hour sooner after initiation of ERAS

Post-operative hospital stay was almost one day less in the post-ERAS group

Post-ERAS patients received only a median of 7.5 morphine milliequivalents of opioids compared to the pre-ERAS group who received a median of 58.1 morphine milliequivalents

All patients in the pre-ERAS group required narcotics, while only 76% utilized narcotics in the post-ERAS group during their hospital stay

Only 64% of post-ERAS patients required opioids post-operatively

There was no difference in post-operative complications between groups

Balancing measures looking specifically at nausea, vomiting, and dehydration requiring admission were either the same or lower in the post-ERAS group, indicating that protocol implementation did not elicit added harm to the patients

Initiation of a targeted ERAS protocol for patients undergoing robotic assisted sleeve gastrectomy led to a significant decrease in narcotic consumption and length of stay without any change in 30-day complication rates