Enhanced recovery concepts in paediatric patients who underwent appendectomy: a retrospective cohort study at a tertiary university hospital.

OBJECTIVE: To investigate if the implementation of enhanced recovery after surgery (ERAS) pathways could be effective in paediatric patients undergoing appendectomy. METHODS: This retrospective study analysed the data from patients aged ≤18 years that underwent appendectomies. The data collected included age, sex, application of enhanced recovery concepts (ERCs) and clinical outcomes. RESULTS: A total of 93 paediatric patients were retrospectively categorized into two groups: patients in group 1 did not experience the use of ERCs during their appendectomies; and patients in group 2 had ERCs applied during their appendectomies. Patients in both groups were exposed to some elements of ERAS, including preoperative patient/parent counselling, limited fasting durations, antibiotic prophylaxis and no bowel preparations. Duration of hospital stay was significantly longer in group 1 compared with group 2 (3.47 ± 1.81 days versus 2.24 ± 1.52 days, respectively. There were no significant differences between the two groups in term of postoperative pain control, hospital cost, readmissions, reoperations and emergency room visits. CONCLUSION: Implementing ERCs in paediatric patients undergoing appendectomies provided a significant improvement in patient recovery with a shorter hospital stay, with no increase in postoperative pain, hospital cost, rate of readmission and reoperation.

Risk factors associated with sickle cell retinopathy: findings from the Cooperative Study of Sickle Cell Disease.

BACKGROUND: Sickle cell retinopathy (SCR) is one of the most important ocular manifestations of sickle cell disease (SCD). This study aims to assess the prevalence of SCR in SCD, identify risk factors for its development and progression to proliferative sickle cell retinopathy (PSCR), and evaluate the potential implications of these results on clinical practice. METHODS: This research is a secondary analysis of patients diagnosed with SCD from the epidemiological, multicenter Cooperative Study of Sickle Cell Disease (CSSCD). We included all patients who completed a full ophthalmic evaluation. We identified clinical and laboratory SCD characteristics associated with SCR using multivariate logistic regression models. Proliferative sickle cell retinopathy (PSCR) was diagnosed according to the Goldberg classification system. RESULTS: Of the 1904 study participants with SCD who met the inclusion criteria, 953 (50.1%) had retinopathy; of which 642 (67.3%) had bilateral disease. SCR was associated with older age (p < 0.001), history of smoking (p = 0.001), hematuria (p = 0.050), and a lower hemoglobin F (HbF) level (p < 0.001). PSCR risk increased with smoking (p = 0.005), older age (p < 0.001) higher hemoglobin level (p < 0.001) and higher white blood cell count (p = 0.011). Previous blood transfusion (p = 0.050), higher reticulocyte count (p = 0.019) and higher HbF level (p < 0.001) were protective factors against the development of PSCR. Ocular symptoms were associated with progression to PSCR in patients with SCR (p = 0.021). CONCLUSION: In this cohort of individuals with SCD, half of the participants had signs of SCR. Smoking and blood hemoglobin level were the two modifiable risk factors associated with increased retinopathy progression. Screening to identify the different stages of retinopathy, actively promoting smoking cessation, and optimizing the hematological profile of patients with SCD should guide treatment protocols designed to prevent the vision-threatening complications of the disease.