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Grabar C, Fligor J, Kanack M, Walsh J, Kim J, Vyas R. A Survey on Enhanced Recovery After Surgery (ERAS) Elements in Cleft Palate Repair. Cleft Palate Craniofac J 2023; 60:1305-1312. [PMID: 35619553 DOI: 10.1177/10556656221103756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to characterize current use, knowledge, and attitude toward ERAS protocols by academic craniofacial surgeons. Craniofacial surgeons were provided with electronic surveys. Electronic survey; Institutional tertiary surgeons. 102 cleft palate surgeons surveyed and 31 completed the survey (30.4%). None. Respondents rated their knowledge, use, and willingness to implement perioperative interventions modeled after adult ERAS protocols. Majority (67.7%) rated they were knowledgeable about ERAS. However, 61.3% "never use" a standardized protocol for cleft palate surgery. Only 3 ERAS elements are currently implemented by a majority of cleft surgeons: avoiding prolonged perioperative fasting (67.7%), using hypothermia prevention measures (74.2%), and minimizing use of opioids (62.5%). A large majority of respondents noted they never administer bolus (71.0%) or infusion (80.6%) dosing of tranexamic acid; most of these surgeons also indicated that administering tranexamic acid "would not be a valuable addition" (67.7% and 71.0%, respectively). Short-acting sedatives are used by 12.9% and by 16.1% of surgeons in all patients during extubation and postoperative recovery, respectively. By contrast, 22.6% never use such agents during extubation and 48.4% never use it during postoperative recovery. Overall, 67.7% of respondents replied that they would be willing to implement an ERAS protocol for cleft palate repair. Many respondents report using interventions compatible with an ERAS approach and the majority are willing to implement an ERAS protocol for cleft palate repair.
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Affiliation(s)
- Christina Grabar
- School of Medicine, University of California Irvine, Orange, CA, USA
| | - Jennifer Fligor
- Department of Plastic Surgery, University of California Irvine, Orange, CA, USA
| | - Melissa Kanack
- Department of Plastic Surgery, University of California Irvine, Orange, CA, USA
| | - Juleah Walsh
- Pediatric Plastic Surgery, CHOC Children's, Orange, CA, USA
| | - Joe Kim
- Pediatric Plastic Surgery, CHOC Children's, Orange, CA, USA
| | - Raj Vyas
- Department of Plastic Surgery, University of California Irvine, Orange, CA, USA
- Pediatric Plastic Surgery, CHOC Children's, Orange, CA, USA
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Martin LD, Franz AM, Rampersad SE, Ojo B, Low DK, Martin LD, Hunyady AI, Flack SH, Geiduschek JM. Outcomes for 41 260 pediatric surgical patients with opioid-free anesthesia: One center's experience. Paediatr Anaesth 2023; 33:699-709. [PMID: 37300350 DOI: 10.1111/pan.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Opioid use is common and associated with side effects and risks. Consequently, analgesic strategies to reduce opioid utilization have been developed. Regional anesthesia and multimodal strategies are central tenets of enhanced recovery pathways and facilitate reduced perioperative opioid use. Opioid-free anesthesia (OFA) protocols eliminate all intraoperative opioids, reserving opioids for postoperative rescue treatment. Systematic reviews show variable results for OFA. METHODS In a series of Quality Improvement (QI) projects, multidisciplinary teams developed interventions to test and spread OFA first in our ambulatory surgery center (ASC) and then in our hospital. Outcome measures were tracked using statistical process control charts to increase the adoption of OFA. RESULTS Between January 1, 2016, and September 30, 2022, 19 872 of 28 574 ASC patients received OFA, increasing from 30% to 98%. Post Anesthesia Care Unit (PACU) maximum pain score, opioid-rescue rate, and postoperative nausea and vomiting (PONV) treatment all decreased concomitantly. The use of OFA now represents our ambulatory standard practice. Over the same timeframe, the spread of this practice to our hospital led to 21 388 of 64 859 patients undergoing select procedures with OFA, increasing from 15% to 60%. Opioid rescue rate and PONV treatment in PACU decreased while hospital maximum pain scores and length of stay were stable. Two procedural examples with OFA benefits were identified. The use of OFA allowed relaxation of adenotonsillectomy admission criteria, resulting in 52 hospital patient days saved. Transition to OFA for laparoscopic appendectomy occurred concomitantly with a decrease in the mean hospital length of stay from 2.9 to 1.4 days, representing a savings of >500 hospital patient days/year. CONCLUSIONS These QI projects demonstrated that most pediatric ambulatory and select inpatient surgeries are amenable to OFA techniques which may reduce PONV without worsening pain.
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Affiliation(s)
- Lynn D Martin
- Department of Anesthesiology & Pain Medicine and Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Amber M Franz
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Sally E Rampersad
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Bukola Ojo
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Daniel K Low
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Lizabeth D Martin
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Agnes I Hunyady
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Sean H Flack
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeremy M Geiduschek
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
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Balbale SN, Cho M, Raval MV, Close SM. Role of patient and family engagement in quality improvement for pediatric surgery. Semin Pediatr Surg 2023; 32:151281. [PMID: 37094531 DOI: 10.1016/j.sempedsurg.2023.151281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
In recent decades, the role of quality improvement (QI) in pediatric surgery has grown substantially. Patient and family engagement can help to maximize the impact of QI by enhancing safety and patient outcomes. Yet, broader, systematic efforts to actively involve patients and families in QI initiatives remain a persistent gap in pediatric surgery. To address this gap, we propose an agenda centered on three key goals for future quality improvement efforts: (1) building partnerships with patients and their families; (2) expanding the use of patient-reported outcomes (PROs) and novel, cross-disciplinary research methods; and (3) engaging patients and families consistently across all stages of pediatric surgical care. Fulfilling this agenda will be essential in shifting our mindset to view QI as a collective that involves patients, families, clinicians, and payers in continuous, system-wide opportunities to evaluate and improve care. Actively listening to and collaborating with patients and families may also help renew our focus on narrowing the gap between current practice and the best possible practice for children undergoing surgery.
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Affiliation(s)
- Salva N Balbale
- Division of Gastroenterology and Hepatology, Department of Medicine; Department of Medical Social Sciences; Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery; & Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (IPHAM), Northwestern University Feinberg School of Medicine, Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Edward Hines, Jr. VA Hospital, Hines, IL.
| | | | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sharron M Close
- Department of Pediatric Advanced Practice Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Cobianchi L, Dal Mas F, Agnoletti V, Ansaloni L, Biffl W, Butturini G, Campostrini S, Catena F, Denicolai S, Fugazzola P, Martellucci J, Massaro M, Previtali P, Ruta F, Venturi A, Woltz S, Kaafarani HM, Loftus TJ, Aapoäÿlu R, Abbott KL, Abdelmalik A, Abebe NS, Abu-Zidan F, Adam YAY, Adamou H, Adamovich DM, Agresta F, Agrusa A, Akin E, Alessiani M, Alexandrino H, Bidoli C, Ali SM, Mihai VA, Almeida PM, Al-Shehari MM, Altomare M, Amico F, Ammendola M, Andreuccetti J, Anestiadou E, Annicchiarico A, Antonelli A, Aparicio-Sanchez D, Ardito A, Argenio G, Arvieux CC, Arvieux C, Askevold IH, Atanasov BT, Augustin G, Awad SS, Bacchiocchi G, Bagnoli C, Bahouth H, Baili E, Bains L, Baiocchi GL, Bala M, Balaguà© C, Balalis D, Baldini E, Baraket O, Baral S, Barone M, Gonzãlez Barranquero A, Barreras JA, Bass GA, Bayhan Z, Bellanova G, Ben-Ishay O, Bert F, Bianchi V, Biancuzzi H, Radulescu RB, Bignell MB, Biloslavo A, Bini R, Bissacco D, Boati P, Boddaert G, Bogdanic B, Bombardini C, Bonavina L, Bonomo L, Bottari A, Bouliaris K, Brachini G, Brillantino A, Brisinda G, Bulanauca MM, Buonomo LA, Burcharth J, Buscemi S, Calabretto F, Calini G, Calu V, Campanile FC, Campo Dall’Orto R, Campos-Serra A, Carvas JM, Cascella M, Pattacini GC, Celentano V, Centonze DC, Ceresoli M, Chatzipetris D, Chessa A, Chiarello MM, Chirica M, Chooklin S, Chouliaras C, Chowdhury S, Cianci P, Cillara N, Cimbanassi S, Cioffi SPB, Colãis-Ruiz E, Colak E, Conti L, Coppola A, de Sa TC, Costa SD, Cozza V, Curro’ G, Dabekaussen KFASA, D’acapito F, Damaskos D, D’Ambrosio G, Das K, Davies RJ, de Beaux AC, De Lebrusant Fernandez SP, De Luca A, De Simone B, De Stefano F, Degrate L, Demetrashvili Z, Demetriades AK, Detanac DS, Dezi A, Di Buono G, Carlo IDI, Di Lascio P, Di Martino M, Di Saverio S, Diaconescu B, Diaz JJ, Dibra R, Dimitrov EN, Dinuzzi VP, Dios-Barbeito S, Diyani JFA, Dogjani A, Domanin M, D’Oria M, Munoz-Cruzado VD, East B, Ekelund M, Ekwen GT, Elbaih AH, Elhadi M, Enninghorst N, Ernisova M, Escalera-Antezana JP, Esposito S, Esposito G, Estaire-Gãmez M, Farã CN, Farre R, Favi F, Ferrario L, Ferrario di Tor Vajana A, Filisetti C, Fleres F, Fonseca VC, Forero-Torres A, Forfori F, Fortuna L, Fradelos E, Fraga GP, Fransvea P, Frassini S, Frazzetta G, Frigerio I, Frountzas M, Gachabayov M, Galeiras R, Garcãa BM, Garcia Vazquez A, Gargarella S, Garzali IU, Ghannam WM, Ghazi FN, Gillman LM, Gioco R, Giordano A, Giordano L, Giove C, Giraudo G, Giuffrida M, Capponi MG, Gois E, Gomes CA, Gomes FC, Gonsaga RAT, Gonullu E, Goosen J, Goranovic T, Gracia-Roman R, Graziano GMP, Griffiths EA, Guagni T, Hadzhiev DB, Haidar MG, Hamid HKS, Hardcastle TC, Hayati F, Healey AJ, Hecker A, Hecker M, Garcia EFH, hodonou AM, huaman EC, Huerta M, Ibrahim AF, Ibrahim BMS, Ietto G, Inama M, Ioannidis O, Isik A, Ismail N, Ismail AMH, Jailani RUHIF, Jang JY, Kalfountzos C, Kalipershad SNR, Kaouras E, Kaplan LJ, Kara Y, Karamagioli E, Karamarkovia A, Katsaros I, Kavalakat AJ, Kechagias A, Kenig J, Kessel BJ, Khan JS, Khokha V, Kim JI, Kirkpatrick AW, Klappenbach R, Kobe Y, Lymperis EK, Kok KYY, Kong V, Korkolis DP, Koukoulis G, Kovacevic B, Kruger VF, Kryvoruchko IA, Kurihara H, Kuriyama A, Landaluce-Olavarria A, Lapolla P, Licari L, Lisi G, Litvin A, Lizarazu A, Bayo HL, Lohsiriwat V, Moreira CCL, Lostoridis E, Luna AT, Luppi D, V. GMM, Maegele M, Maggiore D, Magnone S, Maier RV, Maier RV, Major P, Manangi M, manetti A, Mantoglu B, Marafante C, Mariani F, Marinis A, Mariot ES, Marseglia GR, Martãnez-Pãrez A, Martines G, Perez AM, Martino C, Mascagni P, Massalou D, Matãas-Garcãa B, Mazzarella G, Mazzarolo G, Melo RB, Mendoza-Moreno F, Meric S, Meyer J, Miceli L, Michalopoulos NV, Milana F, Mingoli A, Mishra TS, Mohamed M, Mohamed MIEA, Mohamedahmed AY, Mohammed MJS, Mohan R, Moore EE, Morales-Garcia D, Muhrbeck M, Mulita F, Mustafa SMS, Muttillo EM, Naimzada MD, Navsaria PH, Negoi I, Nespoli L, Nguyen C, Nidaw MK, Nigri G, Nikolopoulos I, O’Connor DB, Ogundipe HD, Oliveri C, Olmi S, Ong ECW, Orecchia L, Osipov AV, Othman MF, Pace M, Pacilli M, Pagani L, Palomba G, Pantalone D, Panyko A, Paolillo C, Papa MV, Papaconstantinou D, Papadoliopoulou M, Papadopoulos A, Papis D, Pararas N, Parreira JG, Parry NG, Pata F, Patel T, Paterson-Brown S, Pavone G, Pecchini F, Pellino G, Pelloni M, Peloso A, del Pozo EP, Pereira RG, Pereira BM, perez AL, Perra T, Perrone G, Pesce A, Petagna L, Petracca G, Phupong V, Picardi B, Picciariello A, Piccoli M, Piccolo D, Picetti E, Pikoulis Pikoulis E, Pintar T, Pirozzolo G, Piscioneri F, Podda M, Porcu A, Privitera F, Punzo C, Quaresima S, Quiodettis MA, Qvist N, Rahim R, de Almeida FR, Ramely RB, Rasa HK, Reichert M, Reinisch-Liese A, Renne A, Riccetti C, Rodriguez-Luna MR, Roizblatt D, Romanzi A, Romeo L, Roscio FPM, Rosnelifaizur RB, Rossi S, Rubiano AM, Ruiz-Úcar E, Sakakushev BE, Salamea JC, Sall I, Samarakoon LB, Sammartano F, Arteaga AS, Sanchez-Cordero S, Santoanastaso DPM, Sasia D, Sato N, Savchuk A, Sawyer RG, Scaioli G, Schizas D, Sebastiani S, Seeliger B, Lohse HAS, Seretis C, Sermonesi G, Serradilla-Martin M, Shelat VG, Shlyapnikov S, Sidiropoulos T, Simoes RL, Siragusa L, Siribumrungwong B, Slavchev M, Solaini L, soldini G, Sopuev A, Soreide K, Sovatzidis A, Stahel PF, Strickland M, Sultan MAH, Sydorchuk R, Sydorchuk L, Syed SMAM, Syed AM, Tallon-Aguilar L, Tamburini AM, Tamini N, Tan ECTH, Tan JH, Tarasconi A, Tartaglia N, Tartaglia G, Tartaglia D, Taylor JV, Tebala GD, Gonsaga RAT, Teuben M, Theodorou A, Tolonen M, Tomasicchio G, Toro A, Torre B, Triantafyllou T, Trigiante Trigiante G, Tripepi M, Trostchansky J, Tsekouras K, Turrado-Rodriguez V, Tutino R, Uccelli M, Uchikov PA, Ugarte-Sierra B, Ukkonen MT, Vailas M, Vassiliu PG, Vazquez AG, Vazquez RG, Verde JE, Verde JM, Veroux M, Viganò J, Vilallonga R, Visconti D, Vittori A, Waledziak M, Wannatoop T, Widmer LW, Wilson MSJ, Wong TH, Xenaki S, Yu B, Yule S, Zachariah SK, Zacharis G, Zaghi C, Zakaria AD, Zambrano DA, Zampitis N, Zampogna B, Zanghã S, Zapsalis K, Zattoni F, Zese M, Farre SP, Atanasov BT, Pegoraro V, Zantedeschi M, Reitano E, Pizzocaro E. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J Emerg Surg 2023; 18:14. [PMID: 36803568 PMCID: PMC9936681 DOI: 10.1186/s13017-022-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy.
| | - Francesca Dal Mas
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, PV Italy ,grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Walter Biffl
- grid.415402.60000 0004 0449 3295Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Giovanni Butturini
- grid.513352.3Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Stefano Campostrini
- grid.7240.10000 0004 1763 0578Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Stefano Denicolai
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Jacopo Martellucci
- grid.24704.350000 0004 1759 9494Department of Surgery, Careggi University Hospital, Florence, Italy
| | - Maurizio Massaro
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Pietro Previtali
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | - Alessandro Venturi
- grid.8982.b0000 0004 1762 5736Department of Political and Social Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sarah Woltz
- grid.416219.90000 0004 0568 6419Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Haytham M. Kaafarani
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - Tyler J. Loftus
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, Gainesville, FL USA
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Martin LD, Chiem JL, Hansen EE, Low DK, Reece K, Casey C, Wingate CS, Bezzo LK, Merguerian PA, Parikh SR, Susarla SM, O'Reilly-Shah VN. Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative. Anesth Analg 2022; 135:1271-1281. [PMID: 36384014 DOI: 10.1213/ane.0000000000006256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) was first established in 2001 focusing on recovery from complex surgical procedures in adults and recently expanded to ambulatory surgery. The evidence for ERAS in children is limited. In 2018, recognized experts began developing needed pediatric evidence. Center-wide efforts involving all ambulatory surgical patients and procedures have not previously been described. METHODS A comprehensive assessment and gap analysis of ERAS elements in our ambulatory center identified 11 of 19 existing elements. The leadership committed to implementing an Enhanced Recovery Program (ERP) to improve existing elements and close as many remaining gaps as possible. A quality improvement (QI) team was launched to improve 5 existing ERP elements and to introduce 6 new elements (target 17/19 ERP elements). The project plan was broken into 1 preparation phase to collect baseline data and 3 implementation phases to enhance existing and implement new elements. Statistical process control methodology was used. Team countermeasures were based on available evidence. A consensus process was used to resolve disagreement. Monthly meetings were held to share real-time data, gather new feedback, and modify countermeasure plans as needed. The primary outcome measure selected was mean postanesthesia care unit (PACU) length of stay (LOS). Secondary outcomes measures were mean maximum pain score in PACU and patient/family satisfaction scores. RESULTS The team had expanded the pool of active ERP elements from 11 to 16 of 19. The mean PACU LOS demonstrated significant reduction (early in phase 1 and again in phase 3). No change was seen for the mean maximum pain score in PACU or surgical complication rates. Patient/family satisfaction scores were high and sustained throughout the period of study (91.1% ± 5.7%). Patient/family and provider engagement/compliance were high. CONCLUSIONS This QI project demonstrated the feasibility of pediatric ERP in an ambulatory surgical setting. Furthermore, a center-wide approach was shown to be possible. Additional studies are needed to determine the relevance of this project to other institutions.
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Affiliation(s)
- Lynn D Martin
- From the Departments of Anesthesiology & Pain Medicine and Pediatrics
| | - Jennifer L Chiem
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth E Hansen
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Daniel K Low
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Kayla Reece
- Department of Perioperative Services, Seattle Children's Hospital, Seattle, Washington; and Departments of
| | - Corrie Casey
- Department of Perioperative Services, Seattle Children's Hospital, Seattle, Washington; and Departments of
| | - Christina S Wingate
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Leah K Bezzo
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | | | - Sanjay R Parikh
- Plastic Surgery, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Srinivas M Susarla
- Plastic Surgery, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Vikas N O'Reilly-Shah
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
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Zhang Q, Zhou T, Hou P, Mu W, Wang D, Fang J, Li A. A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors. Thorac Cancer 2022; 14:44-51. [PMID: 36351570 PMCID: PMC9807445 DOI: 10.1111/1759-7714.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills. METHODS A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed. RESULTS All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups (p > 0.05). The open surgery group had an average operation time of 96.5 ± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3 ± 24.51 min (p < 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group (p < 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group (p < 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) (p < 0.05). CONCLUSIONS Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.
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Affiliation(s)
- Qiangye Zhang
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Tingting Zhou
- Thoracic Surgery DepartmentChildren's Hospital Capital Institute of PediatricsBeijingChina
| | - Peimin Hou
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Weijing Mu
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Dongming Wang
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jun Fang
- Pediatric OrthopaedicsYidu Central Hospital of WeifangWeifangChina
| | - Aiwu Li
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
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Davis TL, Schäfer WLA, Blake SC, Close S, Balbale SN, Perry JE, Zarate RP, Ingram M, Strople J, Johnson JK, Holl JL, Raval MV. A qualitative examination of barriers and facilitators of pediatric enhanced recovery protocol implementation among 18 pediatric surgery services. Implement Sci Commun 2022; 3:91. [PMID: 35982503 PMCID: PMC9389824 DOI: 10.1186/s43058-022-00329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Enhanced recovery protocols (ERPs) are an evidence-based intervention to optimize post-surgical recovery. Several studies have demonstrated that the use of an ERP for gastrointestinal surgery results in decreased length of stay, shortened time to a regular diet, and fewer administered opioids, while also trending toward lower complication and 30-day readmission rates. Yet, implementation of ERPs in pediatric surgery is lagging compared to adult surgery. The study’s purpose was to conduct a theory-guided evaluation of barriers and facilitators to ERP implementation at US hospitals with a pediatric surgery service. Methods We conducted semi-structured interviews at 18 hospitals with 48 participants, including pediatric surgeons, anesthesiologists, gastroenterologists, nurses, and physician assistants. Interviews were conducted online, audio-recorded, and transcribed verbatim. To identify barriers and facilitators to ERP implementation, we conducted an analysis using deductive logics based on the five Active Implementation Frameworks (AIFs). Results Effective practices (usable innovations) were challenged by a lack of compliance to ERP elements, and facilitators were having standardized protocols in place and organization support for implementation. Effective implementation (stages of implementation and implementation drivers) had widespread barriers to implementation across the stages from exploration to full implementation. Barriers included needing dedicated teams for ERP implementation and buy-in from hospital leadership. These items, when present, were strong facilitators of effective implementation, in addition to on-site, checklists, protected time to oversee ERP implementation, and order sets for ERP elements built into the electronic medical record. The enabling context (teams) focused on teams’ engagement in ERP implementation and how they collaborated to implement ERPs. Barriers included having surgical team members resistant to change or who were not bought into ERPs in pediatric practice. Facilitators included engaging a multi-disciplinary team and engaging patients and families early in the implementation process. Conclusions Barriers to ERP implementation in pediatric surgery highlighted can be addressed through providing guidelines to ERP implementation, team-based support for change management, and protocols for developing an ERP implementation team. Future steps are to apply and evaluate these strategies in a stepped-wedge, cluster randomized trial to increase the implementation of ERPs at these 18 hospitals.
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Balbale SN, Schäfer WLA, Davis T, Blake SC, Close S, Perry JE, Zarate RP, Ingram MC, Strople J, Johnson JK, Holl JL, Raval MV. Age- and Sex-Specific Needs for Children Undergoing Inflammatory Bowel Disease Surgery: A Qualitative Study. J Surg Res 2022; 274:46-58. [PMID: 35121549 DOI: 10.1016/j.jss.2021.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The use of enhanced recovery protocols (ERP) is extending to pediatric surgical populations, such as patients with inflammatory bowel diseases (IBDs). Given the variation in age- and sex-specific characteristics of pediatric IBD patients, it is important to understand the unique needs of subgroups, such as male versus female or preadolescent versus older patients, when implementing ERPs. We gathered clinician, patient, and caregiver perspectives on age- and sex-specific needs for children undergoing IBD surgery. METHODS We used semistructured interviews and focus groups to assess ERP needs and perceived differences in needs between preadolescent (10-13 y), older (14-19 y), male, and female IBD patients. Participants included clinicians, patients who had recent IBD surgery, and patients' caregivers. RESULTS Forty-eight clinicians, six patients, and eight caregivers participated. Three broad categories of themes emerged: concerns, needs, and experiences related to the (1) surgical care process; (2) continuum of IBD care; and (3) suggestions to make surgical care more patient centered. With regard to surgical care processes, stakeholders reported different communication needs for preadolescent and older children. Key themes about the continuum of IBD care were the need (1) for support from child life specialists and (b) to address young women's health issues. Suggestions to make surgical care more patient centered included providing older children with patient experiences that reflect their perspective as young adults. CONCLUSIONS The findings highlight the need to adopt a patient-centered approach for ERP use that actively addresses age- and sex-specific factors while engaging patients and caregivers as partners with clinicians to improve surgical care for children with IBD.
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Affiliation(s)
- Salva N Balbale
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Willemijn L A Schäfer
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Teaniese Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Sarah C Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sharron Close
- Department of Pediatric Advanced Practice Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Joseph E Perry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Raul Perez Zarate
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Martha-Conley Ingram
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jennifer Strople
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Julie K Johnson
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division and Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, Illinois
| | - Mehul V Raval
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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9
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Bader A. The Value of Preoperative Assessment. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Roy N, Parra MF, Brown ML, Sleeper LA, Carlson L, Rhodes B, Nathan M, Mistry KP, Del Nido PJ. Enhancing Recovery in Congenital Cardiac Surgery. Ann Thorac Surg 2021; 114:1754-1761. [PMID: 34710385 DOI: 10.1016/j.athoracsur.2021.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The benefits of a comprehensive enhanced recovery after surgery (ERAS®) program for the congenital heart disease population are largely unknown. We evaluated adherence and outcomes following a recently implemented enhanced recovery program (ERP) in congenital cardiac surgery. METHODS Patients undergoing elective surgery for simple and moderately complex congenital cardiac surgery followed institutional ERP guidelines since 10/2018. Adherence to guidelines over a 12-month period (P2) was compared to implementation data (P1:5 months). The association of outcomes with continuous time was estimated using linear regression. RESULTS Among 559 patients (representing 40% of the cardiac surgical volume) following the ERP over a period of 17 months, no differences in patient characteristics were observed between periods, except higher incidence of prior operations in P2. Adherence to many aspects of guidelines improved from P1 to P2. Notably, operating room extubation: 27% in P2 vs.16% in P1, p=0.006; decrease in median ventilation time: 6.0-hrs (IQR 0-9.2) in P2 vs. 7.6-hrs (IQR 3.8-12.3) in P1, p=0.002. In addition, there was a reduction in opioids, reported as oral morphine equivalents (OME), most significant for intraoperative OME: 5.00 mg/kg (3.11-7.60) in P2 vs. 6.05 mg/kg (3.77-9.78) in P1, p=0.001. There was no difference in overall intensive care unit (ICU) and postoperative length of stay except in lower risk surgeries. Surgical outcomes were similar in the two periods. CONCLUSIONS An enhanced recovery program reduced the use of opioids, led to more OR extubation and reduced mechanical ventilation duration in patients undergoing congenital cardiac surgery.
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Affiliation(s)
- Nathalie Roy
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - M Fernanda Parra
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Morgan L Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Laura Carlson
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States
| | - Barbara Rhodes
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Kshitij P Mistry
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Rafeeqi T, Pearson EG. Enhanced recovery after surgery in children. Transl Gastroenterol Hepatol 2021; 6:46. [PMID: 34423167 DOI: 10.21037/tgh-20-188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/24/2020] [Indexed: 11/06/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) is a systematic approach to optimize a patient's health and improve clinical outcomes, increase patient satisfaction and decrease healthcare costs. Enhanced recovery protocols have been used across a variety of surgical disciplines and patient groups to improve patient safety and reduce hospital length of stay without increasing return visits to the system. ERAS involves the application of clinical decision making throughout the patient experience with interventions in the preoperative, perioperative and post operative phases. In addition, ERAS is multidisciplinary and the success of an ERAS program is dependent on the effort and integration of stakeholders across the healthcare system. Utilization of ERAS systems have grown across the global adult surgical community over the last three decades and adoption in pediatric surgery has only occurred recently. Hospitals in both adult and pediatric surgery have found that implementation of ERAS systems lead to a shortened length of stay and reduced complications without increasing patient returns to the system. Importantly patients who have surgery within an ERAS program experience less pain, less opioid utilization, a quicker recovery and increased satisfaction. In pediatric surgery ERAS has successfully been employed across most all disciplines from congenital cardiac surgery to colorectal surgery. The evolution of ERAS continues as a paradigm of quality and safety.
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Affiliation(s)
- Talha Rafeeqi
- Department of Surgery, Valley Health System, Las Vegas, NV, USA
| | - Erik G Pearson
- Department of Pediatric Surgery, Sunrise Children's, Las Vegas, NV, USA
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12
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Cawthorn TR, Todd AR, Hardcastle N, Spencer AO, Harrop AR, Fraulin FOG. Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway. Cleft Palate Craniofac J 2021; 59:561-567. [PMID: 34000856 DOI: 10.1177/10556656211017409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. DESIGN Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). PATIENTS Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. INTERVENTIONS A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. MAIN OUTCOME MEASURES Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. RESULTS Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. CONCLUSIONS Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.
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Affiliation(s)
- Thomas R Cawthorn
- Section of Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada
| | - Anna R Todd
- Section of Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada
| | - Nina Hardcastle
- Section of Pediatric Anesthesiology, Department of Anesthesiology, University of Calgary, Alberta, Canada
| | - Adam O Spencer
- Section of Pediatric Anesthesiology, Department of Anesthesiology, University of Calgary, Alberta, Canada
| | - A Robertson Harrop
- Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada
| | - Frankie O G Fraulin
- Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada
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13
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Fuller S, Kumar SR, Roy N, Mahle WT, Romano JC, Nelson JS, Hammel JM, Imamura M, Zhang H, Fremes SE, McHugh-Grant S, Nicolson SC. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2021; 162:931-954. [PMID: 34059337 DOI: 10.1016/j.jtcvs.2021.04.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Stephanie Fuller
- Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - S Ram Kumar
- Division of Cardiac Surgery, Department of Surgery, and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif.
| | - Nathalie Roy
- Department of Cardiac Surgery, Boston Children's Hospital, Department of Surgery, Harvard Medical School, Boston, Mass
| | - William T Mahle
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jennifer C Romano
- Departments of Cardiac Surgery and Pediatrics, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Mich
| | - Jennifer S Nelson
- Department of Cardiovascular Services, Nemours Children's Hospital, and Department of Surgery, University of Central Florida College of Medicine, Orlando, Fla
| | - James M Hammel
- Department of Cardiothoracic Surgery, Children's Hospital and Medical Center of Omaha, Omaha, Neb
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sara McHugh-Grant
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Susan C Nicolson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Penn
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14
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Initial experience introducing an enhanced recovery program in congenital cardiac surgery. J Thorac Cardiovasc Surg 2020; 160:1313-1321.e5. [DOI: 10.1016/j.jtcvs.2019.10.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023]
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Dagg W, Forgeron P, Macartney G, Chartrand J. Parents' management of adolescent patients' postoperative pain after discharge: A qualitative study. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:51-60. [PMID: 33987511 PMCID: PMC7942796 DOI: 10.1080/24740527.2020.1783524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Short hospital admission periods following pediatric inpatient surgery leave parents responsible for managing their child’s postoperative pain in the community following discharge. Little is known about the experiences of parents caring for their child’s postoperative pain after discharge home following inpatient surgery. Research examining parental postoperative pain management following their child’s day surgery has found that parents are challenged in their pain management knowledge and practices. Aims: This interpretative phenomenological analysis study sought to understand parents’ experiences caring for their child’s postoperative pain at home. Methods: Semistructured telephone interviews were conducted with seven parents between 2 weeks and 6 months after their child’s discharge from hospital. Results: Identified themes were coming home without support, managing significant pain at home, and changes in the parent–child relationship. Conclusions: Parents could potentially benefit from nurses optimizing educational interventions, from receiving ongoing support of transitional pain teams, and from assistance with return to school planning.
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Affiliation(s)
- William Dagg
- Faculty of Health Science, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Forgeron
- Faculty of Health Science, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Gail Macartney
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Julie Chartrand
- Faculty of Health Science, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Carantini I, Merlo A, Esposito D, Zerbinati P, Gaiani L, Ferraro F. Long‐term walking ability and patient satisfaction after lower limb functional surgery in patients affected by Charcot‐Marie‐Tooth disease: A retrospective study. J Peripher Nerv Syst 2020; 25:297-302. [DOI: 10.1111/jns.12404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Irene Carantini
- S.C. Riabilitazione Neuromotoria Presidio di BozzoloDipartimento di Neuroscienze Mantova Italy
- ACMT‐Rete per la malattia di Charcot‐Marie‐Tooth OdV Association Bologna Italy
| | - Andrea Merlo
- MerloBioengineering Parma Italy
- Gait & Motion Analysis LaboratorySol et Salus Hospital Rimini Italy
| | - Donatella Esposito
- ACMT‐Rete per la malattia di Charcot‐Marie‐Tooth OdV Association Bologna Italy
| | - Paolo Zerbinati
- Gait & Motion Analysis LaboratorySol et Salus Hospital Rimini Italy
- U.O. NeuroortopediaOspedale Santa Maria Multimedica Castellanza Varese Italy
| | - Luca Gaiani
- Dipartimento di Ortopedia Chirurgica, Azienda USL di ImolaOspedale Santa Maria Della Scaletta Bologna Italy
| | - Francesco Ferraro
- S.C. Riabilitazione Neuromotoria Presidio di BozzoloDipartimento di Neuroscienze Mantova Italy
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Kyrklund K, Sloots CEJ, de Blaauw I, Bjørnland K, Rolle U, Cavalieri D, Francalanci P, Fusaro F, Lemli A, Schwarzer N, Fascetti-Leon F, Thapar N, Johansen LS, Berrebi D, Hugot JP, Crétolle C, Brooks AS, Hofstra RM, Wester T, Pakarinen MP. ERNICA guidelines for the management of rectosigmoid Hirschsprung's disease. Orphanet J Rare Dis 2020; 15:164. [PMID: 32586397 PMCID: PMC7318734 DOI: 10.1186/s13023-020-01362-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hirschsprung's disease (HSCR) is a serious congenital bowel disorder with a prevalence of 1/5000. Currently, there is a lack of systematically developed guidelines to assist clinical decision-making regarding diagnostics and management. AIMS This guideline aims to cover the diagnostics and management of rectosigmoid HSCR up to adulthood. It aims to describe the preferred approach of ERNICA, the European Reference Network for rare inherited and congenital digestive disorders. METHODS Recommendations within key topics covering the care pathway for rectosigmoid HSCR were developed by an international workgroup of experts from 8 European countries within ERNICA European Reference Network from the disciplines of surgery, medicine, histopathology, microbiology, genetics, and patient organization representatives. Recommendation statements were based on a comprehensive review of the available literature and expert consensus. AGREE II and GRADE approaches were used during development. Evidence levels and levels of agreement are noted. RESULTS Thirty-three statements within 9 key areas were generated. Most recommendations were based on expert opinion. CONCLUSION In rare or low-prevalence diseases such as HSCR, there remains limited availability of high-quality clinical evidence. Consensus-based guidelines for care are presented.
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Affiliation(s)
- Kristiina Kyrklund
- Department of Pediatric Surgery, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ivo de Blaauw
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Kristin Bjørnland
- Department of Pediatric Surgery, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Duccio Cavalieri
- Department of Biology, University of Florence, A.Mor.Hi, The Italian Association for Hirschsprung's disease, Florence, Italy
| | - Paola Francalanci
- Pathology Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Fabio Fusaro
- Neonatal Surgery Unit - Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Annette Lemli
- SoMA, The German patient support organization for anorectal malformations and Hirschsprung Disease, Munich, Germany
| | - Nicole Schwarzer
- SoMA, The German patient support organization for anorectal malformations and Hirschsprung Disease, Munich, Germany
| | - Francesco Fascetti-Leon
- Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Nikhil Thapar
- UCL Great Ormond Street Institute of Child Health; Department of Pediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | | | - Dominique Berrebi
- Department of Pediatric Pathology, Hôpital Universitaire Robert Debré, Paris Diderot University, Paris, France
| | - Jean-Pierre Hugot
- Department of Pediatric Gastroenterology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Célia Crétolle
- Department of Pediatric Surgery, University Hospital Necker-Enfants Malades, APHP centre, Paris University, Paris, France
| | - Alice S Brooks
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert M Hofstra
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tomas Wester
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mikko P Pakarinen
- Department of Pediatric Surgery, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Dagg B, Forgeron P, Macartney G, Chartrand J. Adolescent Patients' Management of Postoperative Pain after Discharge: A Qualitative Study. Pain Manag Nurs 2020; 21:565-571. [PMID: 32553416 DOI: 10.1016/j.pmn.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/30/2020] [Accepted: 04/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adolescents are typically admitted for a short period of time after inpatient surgery, leaving much of their recovery to occur at home. Pain, and thus pain management, is a major component of recovery at home. Research among pediatric outpatient surgical patients has found that pain experienced in the community setting after discharge is often severe and is related to knowledge deficits resulting in inadequate pain management. However, there is little research on community pain management after inpatient surgery. AIM This study aimed to explore the pain experiences of seven adolescents who underwent inpatient surgery. DESIGN This study used Interpretative Phenomenological Analysis as a methodology. SETTING This study took place at a pediatric tertiary care hospital in Canada. PARTICIPANTS 7 adolescents participated, all of whom underwent inpatient surgery with admission between 2-14 days in length. METHODS Semi-structured interviews were conducted 2 to 6 weeks post-discharge. RESULTS Three themes were identified that described their experiences, including managing severe pain at home with minimal preparation, changes in the parent-child relationship, and difficulties returning to school and regular activities. CONCLUSIONS Involving adolescents directly in discharge education, particularly with the use of novel interventions and coaching, may improve outcomes. KEY PRACTICE POINTS Adolescent patients experience significant pain after discharge from hospital after inpatient surgical procedures. Adolescents are in need of adolescent-specific pain management education to increase skill and knowledge and address pain management-related misconceptions. Greater emphasis on involving adolescents in their own pain care and novel intervention could prove useful in improving outcomes.
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Affiliation(s)
- Bill Dagg
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
| | - Paula Forgeron
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Gail Macartney
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edwar Island, Canada
| | - Julie Chartrand
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Rosenfeld EH, Yu YR, Fernandes NJ, Karediya A, Wesson DE, Lopez ME, Shah SR, Vogel AM, Brandt ML. Bowel preparation for colostomy reversal in children. J Pediatr Surg 2019; 54:1045-1048. [PMID: 30782438 DOI: 10.1016/j.jpedsurg.2019.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Pediatric bowel preparation protocols used before colostomy reversal vary. The aim of this study is to determine institutional practices at our institution and evaluate the impact of bowel preparations on postoperative outcomes and hospital length of stay in children. METHODS This was a retrospective review of children ≤18 years old undergoing colostomy reversal at Texas Children's Hospital (TCH) between 12/2013 and 8/2017. Preoperative bowel regimens and outcomes were collected and analyzed using descriptive statistics, Wilcoxon Rank-Sum and Fishers Exact tests. Continuous variables are presented as median [IQR]. RESULTS Sixty-one children underwent colostomy reversal. Thirty-eight (62%) did not receive a preoperative bowel preparation. The two cohorts were similar in age, gender, and race. The most common indication for colostomy was anorectal malformation for thirty-seven (61%). Time from admission to surgery (19 h [17, 23] vs 3 [2, 3]; p < 0.01) and HLOS (6 days [5, 8] vs 5 [4, 6]; p = 0.02) were both longer in the bowel preparation cohort. Complications (3 [13%] vs 5 [22%]; p = 0.12) and 90-day readmissions (3 [13%] vs 6 [16%]; p = 0.64) were similar in both cohorts. CONCLUSION Foregoing bowel preparation may have the potential to improve cost and reduce morbidity in children undergoing colostomy closure. LEVEL OF EVIDENCE III. STUDY TYPE Treatment study.
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Affiliation(s)
- Eric H Rosenfeld
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Yangyang R Yu
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Nathaniel J Fernandes
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Aleena Karediya
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - David E Wesson
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Monica E Lopez
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Sohail R Shah
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam M Vogel
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Mary L Brandt
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
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