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Swift CA, Fernstrum CJ, Howell HM, Phillips JB, Aultman RB, Baker KE, Thames CB, Bryant GC, Velazquez AE, Boydstun AG, Sullivan JM, Lebhar MS, Hecox EE, Humphries LS, Hoppe IC. Implementation of an Enhanced Recovery After Surgery Protocol for Cranial Vault Remodeling Procedures. Cleft Palate Craniofac J 2024:10556656241255940. [PMID: 38841797 DOI: 10.1177/10556656241255940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cranial vault remodeling for craniosynostosis. The authors aim to describe the implementation of an ERAS protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital. DESCRIPTION Institutional review board approval was received. All patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were collected (n = 168). Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and independent t-tests were employed to determine significance. A significance value of 0.05 was utilized. RESULTS During the time examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution - all of which were included in the analysis. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged. CONCLUSION This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for ways to maximize hospital reimbursement for these procedures, as well as potentially improve outcomes.
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Affiliation(s)
- Clarice A Swift
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Colton J Fernstrum
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Haven M Howell
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John B Phillips
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rebekah B Aultman
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Katherine E Baker
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Clay B Thames
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gidarell C Bryant
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Anna G Boydstun
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John M Sullivan
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Michael S Lebhar
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Emily E Hecox
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Laura S Humphries
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Ian C Hoppe
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
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