Mechanical bowel preparation for children undergoing elective colorectal surgery.

OBJECTIVES: Adult literature supports the elimination of mechanical bowel preparation (MBP) for elective colorectal surgical procedures. Prospective data for the pediatric population regarding the utility of MBP are lacking. The primary aim of this study was to compare infectious complications, specifically anastomotic leak, intraabdominal abscess, and wound infection in patients who received MBP with those who did not. METHODS: A randomized pilot study comparing MBP with polyethylene glycol with no MBP was performed. Patients, 0 to 21 years old, undergoing elective colorectal surgery were eligible and randomized within 4 age strata. Statistical analyses were performed using χ or Fisher exact test for categorical data and t test or Wilcoxon 2-sample test for continuous data. RESULTS: Forty-four patients were enrolled in the study from December 2010 to February 2013, of which 24 (55%) received MBP and 20 (45%) did not. Two patients (5%) had anastomotic leak, 4 (9%) had intraabdominal infection, and 7 (16%) had wound infections. The rate of anastomotic leak, intraabdominal abscess, and wound infection did not differ between the 2 groups. CONCLUSIONS: MBP for elective colorectal surgery in children does not affect the incidence of infectious complications. A larger multiinstitutional study is necessary to validate the results of this single-institution pilot study.

Utilization of an Enhanced Recovery After Surgery (ERAS) protocol for pediatric metabolic and bariatric surgery.

INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols for pediatric metabolic and bariatric surgery are limited. In 2018, an ERAS protocol for patients undergoing robotically assisted vertical sleeve gastrectomy (r-VSG) was instituted. This study's aim was to compare outcomes before and after ERAS initiation. METHODS: A single institution retrospective review of patients undergoing r-VSG from July 2015 to July 2021 was performed. The multimodal ERAS protocol focused on limiting post-operative nausea and narcotic utilization. Subjects were categorized into non-ERAS (July 2015-July 2018) and ERAS (August 2018-July 2021) groups. In-hospital and 30-day outcomes were compared. RESULTS: 110 subjects (94 females) with a median age of 17.6 years (range 12.5-22.0 years) were included (60 non-ERAS, 50 ERAS). Demographics were similar except for a higher proportion of females in the non-ERAS group (97% vs 72%, p < 0.001). A significant decrease in narcotic use (p < 0.001) and higher utilization of acetaminophen (p < 0.001) and ketorolac (p < 0.001) was observed in the ERAS group. Additionally, median time to oral intake, a proxy for postoperative nausea and vomiting [2:00 h (1:15, 2:30) vs. 3:22 h (2:03, 6:15), p < 0.001] and hospital length of stay (LOS) [1.25 days (1.14, 1.34) vs. 2.16 days (1.48, 2.42), p < 0.001] were shorter in the ERAS group. Eleven subjects (10%; ERAS = 5, non-ERAS = 6) experienced post-discharge dehydration, prompting readmission 8 times for 7 (6%) individuals. CONCLUSION: Utilization of ERAS led to a significant decrease narcotic utilization, time to first oral intake, and hospital LOS with no change in adverse events following pediatric metabolic and bariatric surgery. Larger studies, including comparative analysis of health care utilization, should be carried out. LEVEL OF EVIDENCE: III. TYPE OF STUDY: Treatment Study.

The role of the nurse practitioner in level II trauma at Nationwide Children's Hospital.

Most institutions undoubtedly value the role of nurse practitioners (NPs) in a variety of specialties. The NPs derive diagnostic decision-making skills from their educational training, which is rooted in the medical model, and through patient-centered, diagnostic reasoning and care planning. Ultimately, NPs provide cost-effective yet comprehensive medical care complemented by a holistic nursing approach. The trauma department at Nationwide Children's Hospital, Columbus, Ohio, has set forth a goal to have all trauma patients either discharged or admitted within 3 hours of arrival to the emergency department. This article is designed to evaluate the efficacy of NP response to level II trauma transfers and the attempt to improve length of stay. Evaluation of the available date does in fact demonstrate that when the NP is available to respond to the level II transfers, the patient length of stay is significantly decreased.