Implementation Science Fundamentals: Pediatric Surgery Enhanced Recovery After Surgery Protocol for Pectus Repair

Authors

Allison R. Thompson, Department of Health Behavior and Health Education, School of Public Health, University of Michigan
Hannah Glick, University of Michigan Medical School, Ann Arbor, Michigan.
Nathan S. Rubalcava, Department of Surgery, Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona; Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
Jack P. Vernamonti, Department of Surgery, Maine Medical Center, Portland, Maine.Follow
K Elizabeth Speck, Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.

Document Type

Article

Publication Date

11-21-2022

Institution/Department

Surgery

Journal Title

The Journal of Surgical Research

Abstract

INTRODUCTION: Surgical repair of pectus excavatum and carinatum in children has historically been associated with severe postoperative pain and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, multimodal approach designed to fast-track surgical care. However, obstacles to implementation have led to very few within pediatric surgery. The aim of this study is to outline the process of development and implementation of an ERAS protocol for pectus surgical repair using fundamental principles of implementation science. METHODS: A multidisciplinary team of providers worked collaboratively to develop an ERAS protocol for surgical repair of pectus excavatum and carinatum and methods for identifying eligible patients. The surgical champion collaborated with all end users to review and revise the ERAS protocol, assessing all foreseeable barriers and facilitators prior to implementation. RESULTS: Our entire pediatric surgery team, nurses at every stage (clinic/preoperative/recovery/floor), physical therapy, and information technology contributed to the creation and implementation of an ERAS protocol with seven phases of care. The finalized version was implemented by end users focusing on four main areas: pain control, ambulation, diet, and education. Barriers and facilitators were continually addressed with an iterative process to improve the success of implementation. CONCLUSIONS: This is one of the first studies in children which details the step-by-step process of developing and implementing an ERAS protocol for pectus excavatum and carinatum. The process of development and implementation of an ERAS protocol as outlined in this manuscript can serve as a model for future ERAS protocols in pediatric surgery.

Comments

Jack P. Vernamonti- Resident

First Page

313

Last Page

323

Recommended Citation

Thompson AR, Glick H, Rubalcava NS, Vernamonti JP, Speck KE. Implementation Science Fundamentals: Pediatric Surgery Enhanced Recovery After Surgery Protocol for Pectus Repair [published online ahead of print, 2022 Nov 21]. J Surg Res. 2022;283:313-323. doi:10.1016/j.jss.2022.10.018