Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics
Abstract
:1. Introduction
2. Materials and Methods
- Qualification and preparation for surgery and anaesthesia in the Outpatient Clinic,
- Pre-operative preparation of the patient: education via access to the proprietary educational and training app BackOnFeet, prehabilitation (physical activity, diet), and psychological consultation,
- Standardised hospital management of surgical techniques, modes of anaesthesia, options for advanced monitoring, multimodal analgesia and a plan for pain assessment and relief, including novel methods (intraoperative nerve cryoanalgesia),
- Creation of an established interdisciplinary team (orthopaedic surgeons, anaesthetists, physiotherapists, nurses, psychologists, and dieticians) with regular training to implement optimal perioperative care.
- Category 1: reconstructions of the osteoarticular system (osteotomies and long bone lengthening procedures, reconstructions of congenital and acquired bone and joint defects);
- Category 2: multi-tissue reconstructions of osteoarticular and soft tissue defects (pelvic osteotomies with hip reconstruction, multi-tissue reconstructions of peripheral joints);
- Category 3: spinal deformities (scoliosis of various aetiologies);
- Category 4: other procedures.
3. Results
- Lack of prehabilitation;
- No anaesthetic consultation in advance in the Outpatient Clinic area;
- Significantly prolonged preoperative starvation time and excessive fluid restriction (inability to consume carbohydrate-rich beverages before surgery);
- No pre-emptive analgesia;
- Incomplete use of multimodal analgesia;
- Non-routine use of regional analgesia;
- Lack of use of advanced haemodynamic monitoring techniques;
- Long-term use of opioids;
- Delayed start of post-operative rehabilitation due to pain;
- Delayed return to oral feeding.
4. Discussion
4.1. Pre-Operative Period
4.2. Surgery-Anaesthetic Team
4.3. Surgery—Orthopaedic Team
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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ERAS | Our Project |
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PATIENT before surgery | |
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Before surgery TEAM | |
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ANAESTHETIST during surgery | |
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ORTHOPAEDIC during surgery | |
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After surgery TEAM | |
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BEFORE Group (n = 1553) | AFTER Group (n = 2545) | p | |
---|---|---|---|
Age groups n (%) | |||
<1 year old | 23 (2) | 22 (1) | <0.001 |
1–6 | 193 (12) | 223 (9) | |
7–18 | 1337 (86) | 2300 (90) | |
Gender n (%) | |||
Girls | 610 (39) | 1052 (41) | 0.19 |
Boys | 943 (61) | 1493 (59) | |
Category n (%) | |||
Category 1 | 261 (17) | 881 (34) | 0.005 |
Category 2 | 44 (3) | 198 (8) | |
Category 3 | 7 (<1) | 73 (3) | |
Category 4 | 1241 (79) | 1393 (55) | |
Duration of hospitalisation (days, mean ± SD) | |||
Whole group (n = 4098) | 4.76 ± 3.92 | 1.88 ± 2.22 | <0.001 |
Category 1 (n = 1142) | 6.09 ± 3.60 | 1.81 ± 0.73 | <0.001 |
Category 2 (n = 242) | 6.88 ± 2.30 | 2.25 ± 1.09 | |
Category 3 (n = 80) | 16.86 ± 7.14 | 7.14 ± 9.84 |
Year | 2018 | 2019 | 2020 | 2021 | 2022 |
---|---|---|---|---|---|
Cost/revenue | 85.02% | 81.09% | 84.83% | 67.97% | 71.15% |
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Zacha, S.; Szwed, A.; Miegoń, J.; Skonieczna-Żydecka, K.; Andrzejewska, A.; Modrzejewska, E.; Horecki, M.; Jarosz, K.; Biernawska, J. Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics. J. Pers. Med. 2023, 13, 1417. https://doi.org/10.3390/jpm13091417
Zacha S, Szwed A, Miegoń J, Skonieczna-Żydecka K, Andrzejewska A, Modrzejewska E, Horecki M, Jarosz K, Biernawska J. Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics. Journal of Personalized Medicine. 2023; 13(9):1417. https://doi.org/10.3390/jpm13091417
Chicago/Turabian StyleZacha, Sławomir, Aleksander Szwed, Jakub Miegoń, Karolina Skonieczna-Żydecka, Agata Andrzejewska, Elżbieta Modrzejewska, Marcin Horecki, Konrad Jarosz, and Jowita Biernawska. 2023. "Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics" Journal of Personalized Medicine 13, no. 9: 1417. https://doi.org/10.3390/jpm13091417