Enhancing recovery after minimally invasive repair of pectus excavatum

Cristen N. Litz; Sandra M. Farach; Allison Fernandez; Richard Elliott; Jenny Dolan; Will Nelson; Nebbie Walford; Christopher Snyder; Jeffrey P. Jacobs; Ernest K. Amankwah; Paul D. Danielson; Nicole Chandler

doi:10.1007/s00383-017-4148-6

Enhancing recovery after minimally invasive repair of pectus excavatum

Cristen N. Litz, Sandra M. Farach, Allison Fernandez, Richard Elliott, Jenny Dolan, Will Nelson, Nebbie Walford, Christopher Snyder, Jeffrey P. Jacobs, Ernest K. Amankwah, Paul D. Danielson, Nicole Chandler

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Purpose: There are variations in the perioperative management of patients who undergo minimally invasive repair of pectus excavatum (MIRPE). The purpose is to analyze the change in resource utilization after implementation of a standardized practice plan and describe an enhanced recovery pathway. Methods: A standardized practice plan was implemented in 2013. A retrospective review of patients who underwent MIRPE from 2012 to 2015 was performed to evaluate the trends in resource utilization. A pain management protocol was implemented and a retrospective review was performed of patients who underwent repair before (2010–2012) and after (2014–2015) implementation. Results: There were 71 patients included in the review of resource utilization. After implementation, there was a decrease in intensive care unit length of stay (LOS), and laboratory and radiologic studies ordered. There were 64 patients included in the pain protocol analysis. After implementation, postoperative morphine equivalents (3.3 ± 1.4 vs 1.2 ± 0.5 mg/kg, p < 0.01), urinary retention requiring catheterization (33 vs 14%, p = 0.07), and LOS (4 ± 1 vs 2.8 ± 0.8 days, p < 0.01) decreased. Conclusion: The implementation of an enhanced recovery pathway is a feasible and effective way to reduce resource utilization and improve outcomes in pediatric patients who undergo minimally invasive repair of pectus excavatum.

Original language	English (US)
Pages (from-to)	1123-1129
Number of pages	7
Journal	Pediatric Surgery International
Volume	33
Issue number	10
DOIs	https://doi.org/10.1007/s00383-017-4148-6
State	Published - Oct 1 2017
Externally published	Yes

Keywords

Enhanced recovery
MIRPE
Nuss
Pain management
Pectus excavatum
Quality improvement

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Surgery

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10.1007/s00383-017-4148-6

Cite this

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title = "Enhancing recovery after minimally invasive repair of pectus excavatum",

abstract = "Purpose: There are variations in the perioperative management of patients who undergo minimally invasive repair of pectus excavatum (MIRPE). The purpose is to analyze the change in resource utilization after implementation of a standardized practice plan and describe an enhanced recovery pathway. Methods: A standardized practice plan was implemented in 2013. A retrospective review of patients who underwent MIRPE from 2012 to 2015 was performed to evaluate the trends in resource utilization. A pain management protocol was implemented and a retrospective review was performed of patients who underwent repair before (2010–2012) and after (2014–2015) implementation. Results: There were 71 patients included in the review of resource utilization. After implementation, there was a decrease in intensive care unit length of stay (LOS), and laboratory and radiologic studies ordered. There were 64 patients included in the pain protocol analysis. After implementation, postoperative morphine equivalents (3.3 ± 1.4 vs 1.2 ± 0.5 mg/kg, p < 0.01), urinary retention requiring catheterization (33 vs 14%, p = 0.07), and LOS (4 ± 1 vs 2.8 ± 0.8 days, p < 0.01) decreased. Conclusion: The implementation of an enhanced recovery pathway is a feasible and effective way to reduce resource utilization and improve outcomes in pediatric patients who undergo minimally invasive repair of pectus excavatum.",

keywords = "Enhanced recovery, MIRPE, Nuss, Pain management, Pectus excavatum, Quality improvement",

author = "Litz, {Cristen N.} and Farach, {Sandra M.} and Allison Fernandez and Richard Elliott and Jenny Dolan and Will Nelson and Nebbie Walford and Christopher Snyder and Jacobs, {Jeffrey P.} and Amankwah, {Ernest K.} and Danielson, {Paul D.} and Nicole Chandler",

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doi = "10.1007/s00383-017-4148-6",

language = "English (US)",

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T1 - Enhancing recovery after minimally invasive repair of pectus excavatum

AU - Litz, Cristen N.

AU - Farach, Sandra M.

AU - Fernandez, Allison

AU - Elliott, Richard

AU - Dolan, Jenny

AU - Nelson, Will

AU - Walford, Nebbie

AU - Snyder, Christopher

AU - Jacobs, Jeffrey P.

AU - Amankwah, Ernest K.

AU - Danielson, Paul D.

AU - Chandler, Nicole

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Purpose: There are variations in the perioperative management of patients who undergo minimally invasive repair of pectus excavatum (MIRPE). The purpose is to analyze the change in resource utilization after implementation of a standardized practice plan and describe an enhanced recovery pathway. Methods: A standardized practice plan was implemented in 2013. A retrospective review of patients who underwent MIRPE from 2012 to 2015 was performed to evaluate the trends in resource utilization. A pain management protocol was implemented and a retrospective review was performed of patients who underwent repair before (2010–2012) and after (2014–2015) implementation. Results: There were 71 patients included in the review of resource utilization. After implementation, there was a decrease in intensive care unit length of stay (LOS), and laboratory and radiologic studies ordered. There were 64 patients included in the pain protocol analysis. After implementation, postoperative morphine equivalents (3.3 ± 1.4 vs 1.2 ± 0.5 mg/kg, p < 0.01), urinary retention requiring catheterization (33 vs 14%, p = 0.07), and LOS (4 ± 1 vs 2.8 ± 0.8 days, p < 0.01) decreased. Conclusion: The implementation of an enhanced recovery pathway is a feasible and effective way to reduce resource utilization and improve outcomes in pediatric patients who undergo minimally invasive repair of pectus excavatum.

AB - Purpose: There are variations in the perioperative management of patients who undergo minimally invasive repair of pectus excavatum (MIRPE). The purpose is to analyze the change in resource utilization after implementation of a standardized practice plan and describe an enhanced recovery pathway. Methods: A standardized practice plan was implemented in 2013. A retrospective review of patients who underwent MIRPE from 2012 to 2015 was performed to evaluate the trends in resource utilization. A pain management protocol was implemented and a retrospective review was performed of patients who underwent repair before (2010–2012) and after (2014–2015) implementation. Results: There were 71 patients included in the review of resource utilization. After implementation, there was a decrease in intensive care unit length of stay (LOS), and laboratory and radiologic studies ordered. There were 64 patients included in the pain protocol analysis. After implementation, postoperative morphine equivalents (3.3 ± 1.4 vs 1.2 ± 0.5 mg/kg, p < 0.01), urinary retention requiring catheterization (33 vs 14%, p = 0.07), and LOS (4 ± 1 vs 2.8 ± 0.8 days, p < 0.01) decreased. Conclusion: The implementation of an enhanced recovery pathway is a feasible and effective way to reduce resource utilization and improve outcomes in pediatric patients who undergo minimally invasive repair of pectus excavatum.

KW - Enhanced recovery

KW - MIRPE

KW - Nuss

KW - Pain management

KW - Pectus excavatum

KW - Quality improvement

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Enhancing recovery after minimally invasive repair of pectus excavatum

Abstract

Keywords

ASJC Scopus subject areas

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