|Corresponding Author: Claudine Kumba, Department of Pediatric Anesthesia and Critical Care, Necker Enfants Malades University Hospital, 149 Rue de Sèvres, 75015 Paris, France|
|Received: September 17, 2019; Accepted: October 10, 2019; Published: December 09, 2019;|
|Citation: Kumba C. (2019) Future Perspectives of Enhanced Recovery after Surgery in Children. Int J Anaesth Res, 2(3): 89-90.|
|Copyrights: ©2019 Kumba C. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Background: Recently a systematic review and meta-analysis was conducted to determine the impact of Enhanced Recovery after Surgery (ERAS) in children on post-operative outcome.
This study is part of a vast and extended thesis project concerning the impact of goal directed therapies on post-operative outcome in the pediatric population. This trial revealed in 6 non randomized controlled studies in 1620 pediatric patients in appendicetomy. Hypospadias and idiopathic scoliosis surgery that these protocols resulted in reduced post-operative complications in terms of re-operations, infections and re-admissions. Length of hospital (LOS) stay was also reduced.
Systematic reviews and meta-analysis can be high level evidence studies which can help to elaborate recommendations for improvement implementation programs in daily clinical practice.
Objective: To analyze the results, conclusions and future perspective of this recent systematic review and meta-analysis on enhanced recovery after surgery in children and postoperative outcome.
Methods: Editorial concerning the recent systematic review and meta-analysis of ERAS in children.
Results and conclusion: This systematic review and meta-analysis of non-randomized controlled trials revealed 3 aspects: Firstly, randomized controlled trials concerning ERAS in children are lacking. Secondly, Morbidity and LOS were reduced when ERAS protocols were applied. Thirdly not all types of surgery were included, so the results and conclusions of this trial are based on appendicetomy, hypospadias and idiopathic scoliosis surgery. Randomized controlled trials need to be developed to confirm the results. Nevertheless, ERAS should begin to be put into practice using the existing evidence while waiting for the randomized trials to confirm the impact of these protocols on postoperative outcome in children.
Keywords: Enhanced recovery after surgery, Children
The purpose of systematic reviews and meta-analyses is to find an answer to a particular question which can help to improve clinical practices or to implement improvement in our daily clinical management of patients . The ideal systematic review and meta-analyses comprise well conducted randomized controlled trials and evidence raised from these analyses can guide recommendations of high level evidence which can be used to treat or manage patients. In pediatrics and neonatology randomized controlled studies are not always easy to realize for several reasons namely the number of patients, informed consent approval, ethical concerns and so on. A lot of trials in these fields are prospective, observational and retrospective. The recent systematic review and meta-analysis on ERAS in children [2,3] is part of a vast and extended thesis project concerning the impact of goal directed therapies on postoperative outcome in the pediatric population [4-9].
This systematic review and meta-analysis concerned 6 non randomized trials in 1620 pediatric surgical patients and for this reason the level of evidence of this trial was low.
However despite this observation, the results of this systematic review are important and promising enough to recommend continuing to develop randomized controlled trials in this field to reappraise and confirm these results in children. While awaiting the development of these studies, ERAS can be put into practice using the existing evidence.
This systematic review concerned appendicetomy, hypospadias and idiopathic scoliosis surgery. If ERAS reduces postoperative complications in terms of infections, reoperations, readmission and LOS in these settings. It is worthwhile to investigate other pediatric surgical specialties to have a more complete view and impact of these protocols in general in pediatric surgery.
There is still a lot to be done to develop ERAS in children compared to what has been achieved in adults. Based on this systematic review and meta-analysis, there is enough evidence to encourage the development of randomized controlled trials to appraise and confirm the impact of ERAS on post-operative outcome in children.
CONFLICT OF INTEREST
The author declared no conflict of interest.
There was no funding.
To all the collaborators of this project.
1. Rudnicka AR, Owen CG (2012) An introduction to systematic reviews and meta-analysis in health care. Ophtal Physiol Opt 32: 174-183.
2. Kumba C, Blanc T, De Cock A, Willems A, Harte C, et al. (2019) Protocol for rapid recovery pathways after surgery in children: A systematic review and meta-analysis. J Anesth Crit Open Access 11: 42-44.
3. Kumba C, Blanc T, De Cock A, Willems A, Harte C, et al. (2019) Rapid recovery pathways after surgery in children: A systematic review and meta-analysis (CRD42018103518). Med J Clin Trials Case Stud 3: 000211.
4. Kumba C, Mélot C (2019) The era of goal directed therapies in pediatric anesthesia and critical care. EC Emerg Med Crit Care 3: 306-309.
5. Kumba C (2019) Do goal directed therapies improve post-operative outcome in children? (Perioperative goal directed fluid and hemodynamic therapy; transfusion goal directed therapy using viscoelastic methods and enhanced recovery after surgery and postoperative outcome): A study research protocol. Acta Scientific Pediatr 2: 17-19.
6. Kumba C, Cresci F, Picard C Thiry C, Albinni S, et al. (2017) Transfusion and morbi-mortality factors: An observational descriptive retrospective pediatric cohort study. J Anesth Crit Care Open Access 8: 00315.
7. Kumba C, Querciagrossa S, Blanc T, Tréluyer JM (2018) Transfusion and post-operative outcome in pediatric abdominal surgery. J Clin Res Anesthesiol 1: 1-8.
8. Kumba C, Lenoire A, Cairet P, Dogaru-Dedieu E, Belloni I, et al. (2018) Is transfusion an independent risk factor of post-operative outcome in pediatric orthopedic surgical patients? A retrospective study. J Emerg Med Critical Care 4: 7.
9. Kumba C, Taright H, Terzi E, Télion C, Beccaria K, et al. (2018) Blood product transfusion and post-operative outcome in pediatric neurosurgical patients. EC Anesth 4: 288-298.
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