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Enhanced recovery after cleft palate repair: A quality improvement project.
Esfahanian, Mohammad; Marcott, Stephen Craig; Hopkins, Elena; Burkart, Brendan; Khosla, Rohit Kumar; Lorenz, H Peter; Wang, Ellen; De Souza, Elizabeth; Algaze-Yojay, Claudia; Caruso, Thomas J.
Afiliação
  • Esfahanian M; Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
  • Marcott SC; Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
  • Hopkins E; Lucile Packard Children's Hospital Stanford, Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, Palo Alto, California, USA.
  • Burkart B; Center for Pediatric & Maternal Value (CPMV), Lucile Packard Children's Hospital Stanford, Analytics & Clinical Effectiveness, Palo Alto, California, USA.
  • Khosla RK; Lucile Packard Children's Hospital Stanford, Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, Palo Alto, California, USA.
  • Lorenz HP; Division of Plastic & Reconstructive Surgery, Department of Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
  • Wang E; Lucile Packard Children's Hospital Stanford, Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, Palo Alto, California, USA.
  • De Souza E; Division of Plastic & Reconstructive Surgery, Department of Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
  • Algaze-Yojay C; Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
  • Caruso TJ; Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
Paediatr Anaesth ; 32(10): 1104-1112, 2022 10.
Article em En | MEDLINE | ID: mdl-35929340
BACKGROUND: Children undergoing cleft palate repair present challenges to postoperative management due to several factors that can complicate recovery. Utilization of multimodal analgesic protocols can improve outcomes in this population. We report experience designing and implementing an enhanced recovery after surgery (ERAS) pathway for cleft palate repair to optimize postoperative recovery. AIMS: The primary aim was to implement an ERAS pathway with >70% bundle adherence to achieve a 30% reduction in postoperative opioid consumption within 12 months. Our secondary aims assessed intraoperative opioid consumption, length of stay, timeliness of oral intake, and respiratory recovery. METHODS: A multidisciplinary team of perioperative providers developed an ERAS pathway for cleft palate patients. Key drivers included patient and provider education, formal pathway creation and implementation, multimodal pain therapy, and target-based care. Interventions included maxillary nerve blockade and enhanced intra- and postoperative medication regimens. Outcomes were displayed as statistical process control charts. RESULTS: Pathway compliance was 77.0%. Patients during the intervention period (n = 39) experienced a 49% reduction in postoperative opioid consumption (p < .0001) relative to our historical cohort (n = 63), with a mean difference of -0.33 ± 0.11 mg/kg (95% CI -0.55 to -0.12 mg/kg). Intraoperative opioid consumption was reduced by 36% (p = .002), with a mean difference of -0.27 ± 0.09 mg/kg (95% CI -0.45 to -0.09 mg/kg). Additionally, patients in the intervention group had a 45% reduction in time to first oral intake (p = .02) relative to our historical cohort, with a mean difference of -3.81 ± 1.56 h (95% CI -6.9 to -0.70). There was no difference in PACU or hospital length of stay, but there was a significant reduction in variance of all secondary outcomes. CONCLUSION: Opioid reduction and improved timeliness of oral intake is possible with an ERAS protocol for cleft palate repair, but our protocol did not alter PACU or hospital length of stay.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fissura Palatina Tipo de estudo: Etiology_studies / Guideline / Observational_studies Limite: Child / Humans Idioma: En Revista: Paediatr Anaesth Assunto da revista: ANESTESIOLOGIA / PEDIATRIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fissura Palatina Tipo de estudo: Etiology_studies / Guideline / Observational_studies Limite: Child / Humans Idioma: En Revista: Paediatr Anaesth Assunto da revista: ANESTESIOLOGIA / PEDIATRIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos