Abstract
Background and aims
The aim of this study was to investigate fast-track concepts in routine pediatric surgery in a university clinic over 1 year.
Patients/methods
Fast-track concepts were established for procedures requiring hospital admission in patients up to 15 years of age. Patients were studied prospectively from June 2006 to June 2007.
Results
Out of a total of 436 potentially suitable patients, 155 (36%) were finally treated following the protocols. The mean intensity of pain in children younger than 4 years (CHIPPS, 0–10) was 1.3 ± 1.5 the evening of the operation day and decreased to <1 at all other time points. The initial postoperative mean pain intensity in older children (Smiley/VAS, 1–10) was 3.7 ± 2.2 and decreased constantly thereafter. The mean hospital stay of fast-track patients was significantly shorter compared with German diagnosis-related group data (4.6 ± 2.9 versus 9.7 ± 3.8, p < 0.01). There were four (3%) readmissions for minor complications. At follow-up after 2 weeks, 95% of patients and parents judged fast-track care as excellent.
Conclusion
Fast-track concepts are feasible in one third of pediatric patients undergoing routine in-hospital surgery. Fast-track pediatric surgery achieves accelerated convalescence, minimal hospital stay, and high patient and parent satisfaction.
Similar content being viewed by others
References
Kehlet H (2004) Effect of postoperative pain treatment and outcome—current status and future strategies. Langenbecks Arch Surg 389(4):244–249
Wilmore DW, Kehlet H (2001) Management of patients in fast-track surgery. BMJ 322(7304):473–476
Basse L, Jacobson DH, Billesbølle P, Kehlet H (2002) Colostomy closure after Hartmann’s procedure with fast-track rehabilitation. Dis Colon Rectum 45(12):1661–1664
Basse L, Thorbø JE, Løssl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47(3):277–278
Jacobson H, Sonne E, Basse L, Bisgaard T, Kehlet H (2004) Convalescence after colonic resection with fast-track versus conventional care. Scan J Surg 93(1):24–28
Nygren J, Hausel J, Kehlet H, Revhaug A, Lassen K, Dejong CH, Andersen J, von Meyenfeldt M, Ljungqvist O, Fearon KC (2005) A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery. Clin Nutr 24(3):455–461
Grewal H, Sweat J, Vazquez WD (2004) Laparoscopic appendectomy in children can be done as fast-track or same day surgery. JSLS 8(2):151–154
Serour F, Witzling M, Gorenstein A (2005) Is laparoscopic appendectomy in children associated with uncommon postoperative complication. Surg Endosc 19(7):919–922
Mohamed M, Hollins G, Eissa M (2004) Experience in performing pyelolithotomy and pyeloplasty in children in day-surgery basis. Urology 64(4):1220–1222
Jesch NK, Metzelder ML, Kuebler JF, Ure BM (2006) Laparoscopic transperitoneal nephrectomy is feasible in the first year of life and is not affected by kidney size. J Urol 176(3):1177–1179
Metzelder ML, Schier F, Petersen C, Truss M, Ure BM (2006) Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age. J Urol 175(2):688–691
Reismann M, von Kampen M, Laupichler B, Suempelmann R, Schmidt AI, Ure BM (2007) Fast-track surgery in infants and children. J Ped Surg 42(1):234–238
Ure BM, Jesch NK, Glüer S (2002) What’s new in minimally invasive paediatric surgery. Eur J Pediatr Surg 12(6):361–365
Buttner W, Finke W, Hilleke M, Reckert S, Vsianska L, Brambrink A (1998) Development of an observational scale for assessment of postoperative pain in infants. Anesthesiol Intensivmed Notfallmed Schmerzther 33(6):353–361
Keck JF, Gerkensmeyer JE, Joyce BA, Schade JG (1996) Reliability and validity of the faces and word descriptor scales to measure procedural pain. J Pediatr Nurses 11(6):368–374
LaMonatgne LL, Johnson BD, Hepworth JT (1991) Children’s ratings of postoperative pain compared to ratings by nurses and physicians. Issues Compr Pediatr Nurs 14(4):241–247
Murat I, Baujard C, Foussat C, Guyot E, Petel H, Rod B, Ricard C (2005) Tolerance and analgesic efficacy of a new i.v. paracetamol solution in children after inguinal hernia repair. Paediatr Anaesth 15(8):663–670
Eberhart LHJ, Kracke P, Bündgen W, Simon W, Geldner M, Wulf H, Celik I (2004) Entwicklung und Evaluation eines neuen Instruments zur Patientenbeurteilung in der perioperativen Phase (PPP-Fragebogen). Anästh Intensivmed 45:436–443
Metzelder ML, Kuebler JF, Nustede R, Ure BM (2006) Feasibility of endoligasure in laparoscopic transperitoneal hemiureteronephrectomy in children: a comparative study. J Laparoendosc Adv Surg Tech 16(5):522–525
Metzelder ML, Kuebler J, Petersen C, Glüer S, Nusted R, Ure BM (2006) Laparoscopic nephroureterectomy in children—a prospective study on Ligasure versus clip/ligation. Eur J Pediatr Surg 16(4):241–244
Kehlet H (2005) Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res 165:8–13
Sangkhathat S, Patrapinyokul S, Tadyathikom K (2003) Early enteral feeding after closure of colostomy in pediatric patients. J Pediatr Sur 38(10):1516–1519
Ramesh IP, Verghese ST, Hannallah RS, Aregawi A, Patel KM (2001) Fast-tracking children after ambulatory surgery. Anesth Analg 92(4):918–922
Ono M, Fukushima N, Ohtake S, Ichikawah H, Kagisaki K, Matsushita T, Matsuda H (2003) The clinical pathway for fast-track in children after minimally invasive cardiac surgery. Cardiol Young 13(1):44–48
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reismann, M., Dingemann, J., Wolters, M. et al. Fast-track concepts in routine pediatric surgery: a prospective study in 436 infants and children. Langenbecks Arch Surg 394, 529–533 (2009). https://doi.org/10.1007/s00423-008-0440-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-008-0440-1