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Pediatr Surg Int. 2017 Oct;33(10):1123-1129. doi: 10.1007/s00383-017-4148-6. Epub 2017 Aug 29.

Enhancing recovery after minimally invasive repair of pectus excavatum.

Author information

1
Division of Pediatric Surgery, Outpatient Care Center, Johns Hopkins All Children's Hospital, 601 5th Street South, Dept 70-6600, 3rd Floor, St. Petersburg, FL, 33701, USA. clitz@health.usf.edu.
2
Division of Pediatric Surgery, Outpatient Care Center, Johns Hopkins All Children's Hospital, 601 5th Street South, Dept 70-6600, 3rd Floor, St. Petersburg, FL, 33701, USA.
3
Division of Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
4
Division of Cardiothoracic Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
5
Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.

Abstract

PURPOSE:

There are variations in the perioperative management of patients who undergo minimally invasive repair of pectus excavatum (MIRPE). The purpose is to analyze the change in resource utilization after implementation of a standardized practice plan and describe an enhanced recovery pathway.

METHODS:

A standardized practice plan was implemented in 2013. A retrospective review of patients who underwent MIRPE from 2012 to 2015 was performed to evaluate the trends in resource utilization. A pain management protocol was implemented and a retrospective review was performed of patients who underwent repair before (2010-2012) and after (2014-2015) implementation.

RESULTS:

There were 71 patients included in the review of resource utilization. After implementation, there was a decrease in intensive care unit length of stay (LOS), and laboratory and radiologic studies ordered. There were 64 patients included in the pain protocol analysis. After implementation, postoperative morphine equivalents (3.3 ± 1.4 vs 1.2 ± 0.5 mg/kg, p < 0.01), urinary retention requiring catheterization (33 vs 14%, p = 0.07), and LOS (4 ± 1 vs 2.8 ± 0.8 days, p < 0.01) decreased.

CONCLUSION:

The implementation of an enhanced recovery pathway is a feasible and effective way to reduce resource utilization and improve outcomes in pediatric patients who undergo minimally invasive repair of pectus excavatum.

KEYWORDS:

Enhanced recovery; MIRPE; Nuss; Pain management; Pectus excavatum; Quality improvement

PMID:
28852843
DOI:
10.1007/s00383-017-4148-6
[Indexed for MEDLINE]

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