Highlights
- •What is currently known about this topic.
- •ERAS protocols are associated with decreased LOS, increased patient satisfaction, and low complication rates in adults.
- •What new information is contained in this article?
- •An ERAS protocol for pediatric Wilms tumor nephrectomy post operative management can reduce length of stay without an increase in complications.
Abstract
Background
Pediatric unilateral renal tumors in the US are treated with upfront nephrectomy and
surgical staging. We applied enhanced recovery after surgery (ERAS) principles in
care of children after Wilms nephrectomy.
Methods
We reviewed records of pediatric unilateral nephrectomies for Wilms tumors, and analyzed
tumor stage, surgical approach, length of operation, use of anesthesia adjuncts and
catheters, diet advancement, hospital length of stay (LOS), and complications. Our
ERAS protocol includes: parental education regarding discharge criteria and anticipated
LOS, avoiding thoraco abdominal incisions, avoiding routine nasogastric tubes, clear
liquids starting day of surgery, minimizing opiates, routine IV ketorolac use, and
avoiding routine ICU stay. We examined the effects of our protocol on postoperative
hospital LOS and complication rates.
Results
Sixty six children (31 boys, mean age 3.8y, range 0–11.9) underwent unilateral total
nephrectomy for Wilms tumor. Mean nephrectomy duration was 2.7 h. Post operatively,
seven (11%) had temporary gastric tubes and 24 (36%) had epidural catheters. Ten (15%)
recovered in the ICU. Patients were given regular diets mean of 1.9 days post op.
Mean LOS was 3.7 days, with 56% of patients being discharged within 2–3 days. Presence
of tumor thrombus, longer epidural catheter duration, delayed diet advancement, and
total IV narcotic usage were associated with longer LOS. Routine use of IV ketorolac
was associated with shorter LOS.
Conclusions
Use of an ERAS protocol in children undergoing nephrectomy for Wilms tumor is safe,
resulting in rapid return to regular diet and compared to the published literature,
shorter postoperative LOS without an increase in complications or return to ED/OR.
Level of evidence
Level III
Keywords
Abbreviations:
ERAS (enhanced recovery after surgery), LOS (length of stay), COG (children's oncology group), POD (post operative day), EBL (estimated blood loss)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 08, 2022
Accepted:
May 24,
2022
Received in revised form:
May 19,
2022
Received:
October 26,
2021
Identification
Copyright
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