Enhanced Recovery after Surgery (ERAS) in the treatment of congenital duodenal obstruction: A single center cohort study

Purpose: This study aimed to investigate to what extent perioperative routines for treating neonates with congenital duodenal obstruction (CDO) aligned with the proposed Enhanced Recovery After Surgery (ERAS) recommendations for neonates and whether treatment highly corresponding with ERAS improves postoperative outcomes. Method: This is a cohort study of neonates undergoing surgery for CDO at Oslo University Hospital (2009-2020). Data were reviewed in 2022 and compared with the ERAS recommendations; high correspondence was defined as treatment corresponding with > 70% of the recommendations. Results: Of 69 included neonates with CDO, 19 (28%) received treatment highly corresponding with the ERAS recommendations, and the overall median correspondence rate was 62.5 (14-88) %. Forty-two (65%) neonates received opioid treatment postoperatively; median total morphine equivalents were 0.1 mg/kg. Neonates in the high correspondence group received fewer morphine equivalents (p=0.027), but no significant differences were seen in terms of postoperative length of stay and complication rate. The overall correspondence with ERAS recommendations increased during the study period (p<0.001). Conclusion: Many of the ERAS recommendations have been a part of the treatment of neonates with CDO during the last decade. Neonates with treatment highly corresponding to ERAS recommendation received less opioid treatment than neonates with low correspondence.