Journal of Pediatric Surgical Nursing

Enhanced recovery after surgery (ERAS) programs have been utilized among various adult populations, and successful outcomes are well described in the literature. However, similar programs are not well established for children. The aims of this article were to explore the existing literature for current knowledge of the feasibility of enhanced recovery protocols in children, to explore patient and provider experiences with enhanced recovery programs, and to discuss implications for nursing.

Two basic searches were conducted using PubMed/Medline, CINAHL, and EMBASE to identify pediatric ERAS studies and studies discussing patient and nurse experiences with ERAS programs. Keywords included “pediatrics or children,” “enhanced recovery after surgery,” “enhanced recovery,” “fast-track surgery,” “ERAS,” “perioperative,” and “experiences/perceptions/attitudes/views/opinions/feelings.”

The search for pediatric ERAS studies yielded nine studies: five prospective implementations, one retrospective case-match, one retrospective review, one systematic review, one scoping review, and no randomized control studies. There were different combinations of ERAS principles among the studies, ranging from 5 to 12. Outcomes included a decreased hospital length of stay and reduced time to oral nutrition, return of bowel function, and mobilization. The search for experiences with ERAS yielded three qualitative studies and one systematic review: two patient experience and two healthcare provider experience studies.

The literature suggests that ERAS protocols in pediatric surgery can be safely integrated into practice and are an effective method for standardizing care. However, additional high-quality experimental and quasi-experimental studies are needed to analyze the impact of ERAS on pediatric patients.

Postoperative clinic visits are often considered routine practice in pediatric surgery. The purpose of this study was to determine family preferences regarding routine clinic visits among those presenting for postoperative visits.

Patients aged 18–21 years or the parents/guardians of patients aged 0–17 years who underwent appendectomy, pyloromyotomy, umbilical/inguinal hernia repair, circumcision, or supernumerary digit removal between November 18, 2015, and October 28, 2016, were approached at the postoperative visit to complete a survey.

The survey was completed by 151 participants. Clinic visits were preferred by 66% of respondents, and this did not differ by age, educational level, urgency of operation, work/school missed, or frequency of email use. Respondents with concerns that were addressed were more likely to prefer in-office follow-up (79%) compared with those whose concerns were not addressed (44%) or those without concerns (37%; p ≤ .01). There was a trend toward preference for in-office follow-up from respondents who traveled less than 15 minutes (<15 vs. 16–30 vs. >30 minutes: 81% vs. 60% vs. 62%, respectively; p = .09) and those evaluated by surgeons (surgeon vs. advanced practice provider: 71% vs. 58%, respectively; p = .06). Additional interventions were performed in eight patients (5%).

Most families who present for postoperative clinic visits prefer follow-up in clinic despite the resources required to attend the visit.

A trend of dislodged nasogastric tubes was noted in children at a high risk for loss of enteral feeding access. There is known morbidity associated with early nasogastric tube dislodgement. Despite nursing and family education regarding the importance of these surgically placed tubes, the optimal method of securing nasogastric tubes is undetermined.

A nasal bridling program was implemented from February 2015 to February 2017 for pediatric surgical patients less than 1 year old requiring nasoenteric feeding tubes. The pediatric surgical service oversaw education and implementation of the program. Retrospective data collection was performed. Variables included weight and age at the time of tube placement, indications, method of placement, bridle duration, associated complications, unintended dislodgement, and diagnosis outcomes.

Fourteen bridle systems were placed in 12 children with diagnoses including tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease with poor oral skills/feeding, and duodenal atresia and stenosis for 444 patient days. The average duration of bridling was 31.7 days per patient. Of the 14 bridles placed, only one unintended tube removal occurred.

Bridling of nasoenteric feeding tubes is a safe and effective method for preventing unintended tube dislodgement, leading to improved patient care in the pediatric surgical population less than 1 year old. On the basis of our institution's results, ongoing continuing education for use and care of nasoenteric feeding tubes is recommended for the pediatric surgical population.