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Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay

Publication ,  Journal Article
Knackstedt, R; Patel, N
Published in: Plastic and Reconstructive Surgery - Global Open
October 28, 2020

Background: Enhanced recovery after surgery (ERAS) protocols utilize multi-modal approaches to decrease morbidity, narcotic usage, and length of stay. In 2013, we made several changes to our perioperative approach to children undergoing complex craniofacial procedures. The goal of this study was to analyze our protocol for children undergoing fronto-orbital advancement (FOA) for craniosynostosis. Methods: A retrospective chart review was performed after IRB approval, for children who underwent fronto-orbital advancement for craniosynostosis from 2010 to 2018. The ERAS protocol, initiated in December 2013, involves hemoglobin optimization, cell-saver technology, tranexamic acid, specific postoperative fluid titration, and a transfusion algorithm. The analgesic regimen focuses on narcotic reduction through the utilization of scheduled acetaminophen, ibuprofen, or ketorolac, and a dexmedetomidine infusion with opioids only for breakthrough pain. Results: Fifty-five ERAS protocol children and 23 control children were analyzed. ERAS children had a decreased rate (13/53 versus 23/23, P < 0.0001) and volume of intraoperative transfusion (183.4 mL versus 339.8 mL, P = 0.05). Fewer ERAS children required morphine/dilaudid (12/55 versus 22/23 P < 0.0001) and for children who required morphine, fewer doses were required (2.8 versus 11, P = 0.02). For ERAS protocol children who required PO narcotics, fewer doses were required (3.2 versus 5.3, P = 0.02). ERAS children had a decreased length of stay (2.3 versus 3.6 nights, P < 0.0001). No patients were re-admitted due to poor oral intake, pain, hemodynamic, or pulmonary concerns. Conclusions: Our ERAS protocol demonstrated a reduction in the overall and intraoperative allogenic blood transfusion rate, narcotic use, and hospital length of stay. This is a safe and effective multimodal approach to managing complex craniofacial surgical recovery.

Duke Scholars

Published In

Plastic and Reconstructive Surgery - Global Open

DOI

EISSN

2169-7574

Publication Date

October 28, 2020

Volume

8

Issue

10

Start / End Page

E3205
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Knackstedt, R., & Patel, N. (2020). Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay. Plastic and Reconstructive Surgery - Global Open, 8(10), E3205. https://doi.org/10.1097/GOX.0000000000003205
Knackstedt, R., and N. Patel. “Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay.” Plastic and Reconstructive Surgery - Global Open 8, no. 10 (October 28, 2020): E3205. https://doi.org/10.1097/GOX.0000000000003205.
Knackstedt R, Patel N. Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay. Plastic and Reconstructive Surgery - Global Open. 2020 Oct 28;8(10):E3205.
Knackstedt, R., and N. Patel. “Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay.” Plastic and Reconstructive Surgery - Global Open, vol. 8, no. 10, Oct. 2020, p. E3205. Scopus, doi:10.1097/GOX.0000000000003205.
Knackstedt R, Patel N. Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay. Plastic and Reconstructive Surgery - Global Open. 2020 Oct 28;8(10):E3205.

Published In

Plastic and Reconstructive Surgery - Global Open

DOI

EISSN

2169-7574

Publication Date

October 28, 2020

Volume

8

Issue

10

Start / End Page

E3205