Outcomes of Enhanced Recovery After Surgery (Eras) Protocol After Gut Anastomosis in Paediatric Patients

Outcomes of Enhanced Recovery After Surgery (Eras) Protocol After Gut Anastomosis in Paediatric Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of Enhanced Recovery After Surgery (Eras) Protocol After Gut Anastomosis in Paediatric Patients Maliha Nadeem, Nabila Talat, Hamza Malik, Zubair Shoukat, Waseem Zia, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8583890/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND ERAS protocols are comprehensive perioperative care plans designed to facilitate swift recovery. This study is focused on ERAS in pediatric gut anastomosis and contributes valuable insights to perioperative care, with potential implications for future practices. MATERIAL AND METHOD: This study was conducted after approval from IRB, on 100 patients undergoing gut anastomosis. ERAS protocol was applied on all patients. Patients were observed for duration of postoperative hospital stay, wound infection and anastomosis leak. Data was analyzed using SPSS v22.0. Data were presented as mean ± SD for continuous variables and frequency for categorical variables. Pearson correlation coefficients were calculated to assess the strength of linear relationships between paired numerical variables and binary logistic regression test was performed between outcome and various variables. RESULTS Mean age of patients calculated was 4.59 ± 3.64 years. Mean length of hospital stay calculated was 4.63 ± 2.49 days. Only 8% patients suffered from wound infection and 6% patients developed anastomosis leak after surgery. Overall ERAS Protocol was effective in 78% patients and had significant p-value for the time to establish full feed. CONCLUSIONS The implementation of an ERAS protocol in pediatric patients undergoing gut anastomosis demonstrates promising results in terms of reducing the length of hospital stay and potentially lowering the risk of postoperative complications. ERAS Gut Anastomosis Pediatric Population Figures Figure 1 INTRODUCTION The concept of Enhanced Recovery After surgery (ERAS) or fast track recovery protocol was first explained by Henrik Kehlet in 1990s aiming to reduce the postoperative stay of patient by helping them in fast health recovery by optimizing perioperative care through the use of fast track element. 1 , 3 Enhanced Recovery after Surgery (ERAS) protocols defined as patient centered, multimodal perioperative care pathways carried by multidisciplinary team to help the patient attain the early recovery by reducing the surgical stress and enhancing their physiological function. 1 The main purpose of the ERAS protocol is to speed up the post-operative recovery of the patient by applying some perioperative care pathways to reduce the metabolic stress caused by surgery by reducing insulin resistance, minimizing protein breakdown. 1 , 2 , 3 Frequently used surgical procedure in pediatric surgery is intestinal anastomosis involved in stoma reversal, procedures for Hirschsprung’s disease, gut atresia, Biliary atresia, Gut perforation, Intussusception etc. 4 , 5 Many factors can cause different kind of complications after gut anastomosis the most important being leakage that can be lethal and dangerous to patient’s health. 6 , 7 Prolonged patient stay leads to numerous nosocomial infections adding to morbidity and mortality. 4 After a major surgical procedure, to facilitate a quicker return to a speedy recovery for patient, perioperative protocols followed by these guidelines, focus on sustenance of the homeostasis and reducing surgical stress. Bacterial load leading to bacterial infection was initially decreased by Mechanical bowel preps (MBP) whereas osmotic and laxative were included in traditional bowel preparation. 1 , 3 Clinical evidence emphasize that MBP should not be used alone, oral non absorbable antibiotics should be administered along with MBP or without MBP for decreasing the risk of infection as a prophylaxis. 1 , 4 Major principles of ERAS implementation include counseling before surgical procedure, using minimal invasive technique while operating, short or no fasting period, use of regional anesthesia and opioid-sparing analgesia, early postoperative intake of food and mobilization, minimum use of fluid, surgical tubes and drains. Different studies have shown that implementation of enhance recovery after surgery protocols in different adult surgical procedures has reduced the length of stay of patients in hospitals, helps them in fast recovery and, it is cost effective. 6 , 7 The rationale of this study is to highlight the outcome of enhanced recovery protocol after gut anastomosis in pediatric population. There is limited literature on enhanced recovery protocol for pediatric surgery. Various studies have been published discussing the use of this protocol in adult surgery but recently this protocol has been in use by pediatric surgery. According to study of Ghufran S. et all from Egypt mean hospital stay after application of ERAS protocol was 4.59 ± 1.69. 5 According to a study by Fathy M. et all, patients treated with an enhanced recovery protocol had mean length of postoperative stay of 4 ± 1.2 days as compared to 7.1 ± 2.05 days. 8 MATERIALS AND METHODS It was Prospective Descriptive case series done at the Department of Pediatric Surgery, Children’s Hospital and The University of Child Health Sciences, Lahore, Pakistan. The s tudy was conducted over a period of 6 months after the approval of IRB from 3-03-2024 to 3-09-2024.A sample size of 100 cases was calculated using 95% confidence level using anticipated percentage of anastomosis leakage as 8.6% (5) with 5.5% margin of error. Data was collected from the children aged 1 month to 14 years undergoing gut anastomosis surgeries admitted in surgical department of Children Hospital Lahore. A Proforma including consent form was prepared and finalized by pre-testing. Information collected on demography, age, sex, diagnosis, previous surgery, type of surgery (elective or emergency), time of full feed and whether anastomosis leaked or not. Attendants of patients undergoing gut anastomosis were counselled regarding disease, surgical procedure and consent was signed. High carbohydrate containing fluids (4 table spoons of Galaxose-D or simple sugar in 1liter water, juice, Rooh afza) was given till 4hours before surgery in elective surgery. Nasogastric tube and Foley’s catheter were avoided or removed and oral sips were allowed within 24 hours of surgery. Patient was discharged as soon as regular oral feed is established and patient passes stool or flatus. Proformas were filled at the time of discharge. Data Analysis: The collected data was checked by using computer software SPSS (Statistical Package for Social Sciences) version 22.0 and analyzed with same software. Data was represented in mean and standard deviation (SD) for quantitative data e.g., age and length of hospital stay and in terms of frequency for categorical data e.g., gender, type of surgery. Pearson correlation coefficients were calculated to assess the strength of linear relationships between paired numerical variables and outliers were identified through IQR method. Data was stratified for age, gender, diagnosis and type of surgery. Chi-square test was applied for leakage. P-value < 0.05 was taken as significant. Binary logistic regression test was applied to assess the effect of length of stay, time to establish feed, time to remove nasogastric tube and foleys’s catheter and time to start oral sips on the outcome of ERAS Protocol. Results Table 1; summarize the patient’s demographics and clinical details. The median age was 4.59 ± 2.64 years with minimum of 01 month and maximum 14 years’ age. Mean weight calculated was 14.55±8.6 kilograms. A strong correlation was observed between age and weight (0.87) suggestive of normal increased weight with age. In our study 64% were male patients and 36% were female. Male to female ratio is 1.8: 1. 63% patients underwent elective surgery and 37% had emergency surgery. 49% were admitted for enterostomy closure and 51% underwent laparotomy with anastomosis. Among them 32% underwent gut anastomosis in first surgery while rest were previously operated and most of them had enterostomy made in previous surgery. Mean length of hospital stay calculated was 4.63 ±2.49 days with minimum 1 day and outlier 10-18 days. The mean time to start full feed was 3.36±2.0 days with minimum 0.5 days duration. Length of stay had positive correlation with time to establish full feed (0.83) indicating longer stay in patients who took longer time to start full solid feed. Mean time to remove nasogastric tube was 11.7±11.2 hours with few patients in whom nasogastric tube was not inserted, mean time to remove Foley’s catheter was 15.1±9.90 hours and mean time to start clear fluids was 11.5±6.6 hours (Table 2). Only 8% patients suffered from wound infection after surgery but wound infection had a negative correlation with length of stay and time to start full feed. 6% patients developed anastomosis leak after surgery with mean of 6 th day of anastomosis. It had negative correlation index (-0.6) with length of stay and time to start full feed. Children in younger age group had significantly higher hospital stay and complications rate as compared to children in elder age group i.e., 4.91 vs. 3.70 days, (P=0.040) implying ERAS Protocol needs to be modified for the infants. Chi square test applied for anastomosis leak and wound infection showed significant p-value while for age stratification and diagnosis it was insignificant. A binary logistic regression was performed to ascertain the effect of hospital stay, full feed time, time to start oral sips, time to remove nasogastric tube and foley’s catheter on the likelihood of uneventful outcome and it came out to be significant p<0.00. Model explained 38.5% of the variance. Full feed time showed twice the likelihood to have uneventful outcome and was statistically significant (p=0.017) but statistically non-significant likelihood for the rest of the variables, indicating that the earlier feeding is the most potent component of ERAS Protocol (Table 3). Besides wound infection and anastomosis leak, various other minor complications were observed including vomiting (7%), abdominal distention (4%), electrolyte imbalance (1%) and phimosis (1%) which were more common in colostomy reversal, gut tumor resection and strangulated inguinal hernias with significant p-value. Overall 78% had uneventful outcome with ERAS Protocol and 22% of patients had minor and major complications. Table 1: Patient’s demographics and clinical details Variables n=100 Frequency Percentage Age (years) Mean = 4.596 + 3.64 < 5years 66 66.0 5-10years 23 23.0 10.1-14years 11 11.0 Gender Male 64 64.0 Female 36 36.0 Weight (kg) Mean=14.55 + 8.64 < 10 Kg 36 36.0 11 - 22 Kg 53 53.0 23 - 45 Kg 11 11.0 Hemoglobin Level mg/dl Mean = 10.83 + 2.40 Low ( 11.0 mg /dl) 36 36.0 Redo Surgery Yes 8 8.0 No 92 92.0 Type of surgery Elective 63 63.0 Emergency 37 37.0 Wound infection Yes 8 8.0 No 92 92.0 Anastamotic leakage Yes 6 6.0 No 94 94.0 Outcome Good outcome 78 78.0 Failure / poor 22 22.0 Table 2: Mean hospital stay among subjects: Length of hospital stay (days) Time to establish full feed (days) Time to remove NG (hours) Time to remove Foley (hours) Time to start oral sips (hours) Mean 4.63 3.3550 11.7000 15.1000 11.5700 Std. Deviation 2.491 2.00416 11.26315 9.91937 6.69276 Minimum 1 .50 .00 .00 6.00 Maximum 18 14.00 48.00 48.00 24.00 Table 3: Binary logistic regression model of ERAS outcome with hospital stay, feed time, time to remove NG, Foley and start oral sips: Variables in the Equation B S.E. Wald df Sig. Exp(B) Step 1 a Hospital stay .270 .226 1.422 1 .233 1.309 Feed time .873 .365 5.732 1 .017 2.393 Time to remove NG -.061 .040 2.270 1 .132 .941 Time to remove Foley .009 .031 .086 1 .769 1.009 Time to start oral sips .019 .060 .097 1 .755 1.019 Constant -5.213 1.319 15.627 1 .000 .005 a. Variable(s) entered on step 1: hospital stay, feed time, time to remove NG, foley, and start oral sips. DISCUSSION Enhanced Recovery After Surgery (ERAS) protocols have gained significant attention in recent years for their potential to optimize perioperative care and improve outcomes in surgical patients. Initially developed for adult patients, ERAS protocols are now being adapted and implemented in pediatric populations undergoing various surgical procedures, including gut surgeries. 3 The ERAS approach is a multidisciplinary perioperative care pathway designed to minimize surgical stress, reduce complications, and facilitate early recovery. 9 It encompasses a comprehensive set of evidence based perioperative interventions and principles aimed at enhancing patient outcomes and expediting recovery. 10 The findings of our study shed light on the application of the Enhanced Recovery After Surgery (ERAS) protocol in pediatric patients undergoing gut anastomosis. Our analysis revealed a mean age of patients undergoing these procedures to be 4.59 years, with a predominance of males (64%) compared to females (36%). This demographic distribution is consistent with previous studies in pediatric surgical populations. 3 In a study on pediatric population undergoing gut surgery mean age recorded was 3.8 ± 2.1years, and more male as compared to female patients (163 versus 115). 11 Notably, the majority of patients in our study had colostomy reversal (26%), followed by ileostomy reversal (21%) and intussusception (13%). These findings underscore the diverse spectrum of gut surgeries encountered in pediatric practice and highlight the relevance of implementing standardized perioperative care pathways, such as ERAS, across various surgical procedures. The causes of gastrointestinal surgery in children reported include, Meckel's diverticulum with band causing obstruction, obstructed inguinal hernia, postoperative adhesions, congenital peritoneal bands, Hirschsprung's disease, abdominal tuberculosis, typhoid ileal perforation, and umbilical hernia. Acute appendicitis is also a common cause, except in the infancy period where congenital abnormalities predominate. Gastroschisis, midgut volvulus, and abdominal trauma are other indications for lower gastrointestinal surgery in children. 12 Our study also evaluated key clinical outcomes following the implementation of the ERAS protocol. The mean length of hospital stay was 4.63 days, reflecting findings consistent with other similar studies conducted internationally. According to metanalysis including papers from developed countries length of stay reduced to 2.04–7.7 days in ERAS group 21 and being a LMIC 4.63 days stay corresponds to developed countries reducing economic burden on health facilities. Similarly, one meta-analysis showed that Enhanced Recovery After Surgery (ERAS) in pediatric abdominal surgery resulted in reduced length of hospital stay (MD -1.96), time to oral intake (MD -3.37), and time to stool (MD -4.19). ERAS also reduced postoperative complications by 50% and 30-day readmissions by 36%. 3 ERAS implementation as a bundle led to improved postoperative outcomes, including a statistically significant reduction in the rate of postoperative complications by 50% and a 36% reduction in 30-day readmission. 3 , 12 In terms of postoperative complications, our analysis revealed a low incidence of wound infection (8%) and anastomosis leak (6%) in our study population which is consistent with other studies. In recent RCT, the postoperative complication rate noted was significantly lower in the enhanced recovery after surgery (ERAS) group compared to the non-ERAS group (29.6% vs. 55%, p = 0.049). 13 Another meta-analysis showed that the use of Enhanced Recovery After Surgery (ERAS) protocols in gastrointestinal surgery resulted in a decrease in the incidence of lung infection (risk ratio = 0.46, 95% confidence interval 0.27–0.74, P = .002). ERAS protocols also led to a significant reduction in the length of hospitalization after surgery. However, the ERAS protocol groups had higher readmission rates, as well as increased rates of nausea and vomiting. Contrast, to our results in this review there was no significant difference noted in the incidence of anastomotic leakage, ileus, surgical site infection. 14 In conclusion, our study highlights the successful implementation of the Enhanced Recovery After Surgery (ERAS) protocol in pediatric patients undergoing gut anastomosis surgeries at Children's Hospital Lahore. Our findings support the effectiveness of the ERAS protocol in terms of reducing length of postoperative hospital stay and incidence of complications including anastomosis leakage and wound infection. However, infants do not respond much to ERAS Protocol as compared to children above 1 years. Results ERAS Protocol is an effective modality for pediatric gut anastomosis in low middle income countries resulting in earlier postoperative recovery, reduced length of stay and reduced incidence of complications with complete effectiveness in 78% patients. However, ERAS Protocol needs to modified for infants. Declarations Author Contribution M and N made contributions to the conception or design of the work, acquisition, analysis and interpretation of data.M, H, Z and W collected data by implementing the ERAS Protocol, analyzed and interpreted the data.N and F drafted the work and analyzed it critically for important intellectual content. N, H, Z, W and F approved the version to be published.M and Z agree to be accountable for all aspects of work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. References Roberts K, Brindle M, McLuckie D. Enhanced recovery after surgery in paediatrics: a review of the literature. BJA education. 2020;20(7):235-41. Hoffmann H, Kettelhack C. Fast-track surgery–conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. ESR. 2012;49(1):24-34. Rove K, Brockel M, Saltzman A, Dönmez M, Brodie K, Chalmers D, et al. Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations. JPU. 2018;14(3):252. e1-. e9. Vargus M, Sardaneta M, Reyes D, Justo-Janeiro J. Intestinal anastomosis. Clin Surg. 2018;3:1854-6. Ghufran S, Janjua AA, Chaudary SM, Munawwar F, Hassan M, Changazi SH. Outcome of Enhanced Recovery After Surgery Protocols in Patients Undergoing Small Bowel Surgery. Cureus. 2020;12(10). Rove KO, Edney JC, Brockel MA. Enhanced recovery after surgery in children: Promising, evidence‐based multidisciplinary care. Pediatric Anesthesia. 2018;28(6):482-92. Raval MV, Heiss KF. Development of an enhanced recovery protocol for children undergoing gastrointestinal surgery. Current opinion in pediatrics. 2018;30(3):399-404. Fathy M, Khedre M, Nagaty M, Zaghloul M. Enhanced recovery protocol vs traditional methods after resection and reanastomosis in gastrointestinal surgery in pediatric patients. AOPS 2018; 14(4):214- Patil S, Cornett E, Jesunathadas J, et al. Implementing enhanced recovery pathways to improve surgical outcomes. J Anaesthesiol Clin Pharmacol 2019;35:S24-8. Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations — 2019 update. Int J Gynecol Cancer 2019. Mar. 15 [Epub ahead of print]. Shang Q, Geng Q, Zhang X, Xu H, Guo C. The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis. Medicine (Baltimore). 2018 ;97(9):e0045. Shang Q, Geng Q, Zhang X, Xu H, Guo C. The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis. Medicine (Baltimore). 2018 ;97(9):e0045. Dipasquale V, Laganà F, Arrigo S, Trimarchi G, Romeo C, Navarra G, Mattioli G, et al. Enhanced Recovery Care versus Traditional Care after Surgery in Pediatric Patients with Inflammatory Bowel Disease: A Retrospective Case-Control Study. Biomedicines. 2022; 10(9):2209. Feng JY, Wang SF, Yan J. The Application of Enhanced Recovery After Surgery for Gastrectomy and Colorectal Resection: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A. 2023 ;33(6):586-595. Grass F, Hübner M, Demartines N, Hahnloser D.Chirurgie du cancer du côlon en 2021 [Surgery for colon cancer in 2021] https://pubmed.ncbi.nlm.nih.gov/34133092/ Rev Med Suisse. 2021;17:1155–8.. Ellis CT, Maykel JA. Defining anastomotic leak and the clinical relevance of leaks. Clinics in Colon and Rectal Surgery. 2021 Oct 1;34(06):359-65. Pandiaraja J, Chakkarapani R, Arumugam S. A study on patterns, indications, and complications of an enteric stoma. J Family Med Prim Care. 2021 ;10(9):3277-3282. Brindle M.E. Heiss Scott M.J. Herndon C.A. Ljungqvist O. Koyle M.A. Embracing change: the era for pediatric ERAS is here. Pediatr Surg Int. 2019; 35: 631-634 Rafeeqi T, Pearson EG. Enhanced recovery after surgery in children. Transl Gastroenterol Hepatol. 2021 Jul 25;6:46. Sanford E.L. Zurakowski D. Litvinova A. Zalieckas J.M. Cravero J.P. The association between high-volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection. Paediatr Anaesth. 2019; 29: 315-21. Li WTV, Li WK, Chan YC, Cheung TY, Su CK, Tan QXR, Wong TH, Chung PHY. Enhanced Recovery After Surgery in paediatric patients undergoing gastrointestinal surgeries- A scoping review. JPS. 2023 Apr;1 Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":19405,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in Results \u0026nbsp;section.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8583890/v1/d83e38c8206295c1bbf1cee0.png"},{"id":100928021,"identity":"ddd8025c-bdd2-4f52-8bcb-d47b40229c4c","added_by":"auto","created_at":"2026-01-22 23:53:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":616711,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8583890/v1/f154cba6-73bb-47f0-a3b8-7215843d1d37.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eOutcomes of Enhanced Recovery After Surgery (Eras) Protocol After Gut Anastomosis in Paediatric Patients\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe concept of Enhanced Recovery After surgery (ERAS) or fast track recovery protocol was first explained by Henrik Kehlet in 1990s aiming to reduce the postoperative stay of patient by helping them in fast health recovery by optimizing perioperative care through the use of fast track element.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Enhanced Recovery after Surgery (ERAS) protocols defined as patient centered, multimodal perioperative care pathways carried by multidisciplinary team to help the patient attain the early recovery by reducing the surgical stress and enhancing their physiological function.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The main purpose of the ERAS protocol is to speed up the post-operative recovery of the patient by applying some perioperative care pathways to reduce the metabolic stress caused by surgery by reducing insulin resistance, minimizing protein breakdown.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFrequently used surgical procedure in pediatric surgery is intestinal anastomosis involved in stoma reversal, procedures for Hirschsprung\u0026rsquo;s disease, gut atresia, Biliary atresia, Gut perforation, Intussusception etc.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Many factors can cause different kind of complications after gut anastomosis the most important being leakage that can be lethal and dangerous to patient\u0026rsquo;s health.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Prolonged patient stay leads to numerous nosocomial infections adding to morbidity and mortality.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e After a major surgical procedure, to facilitate a quicker return to a speedy recovery for patient, perioperative protocols followed by these guidelines, focus on sustenance of the homeostasis and reducing surgical stress. Bacterial load leading to bacterial infection was initially decreased by Mechanical bowel preps (MBP) whereas osmotic and laxative were included in traditional bowel preparation.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Clinical evidence emphasize that MBP should not be used alone, oral non absorbable antibiotics should be administered along with MBP or without MBP for decreasing the risk of infection as a prophylaxis.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Major principles of ERAS implementation include counseling before surgical procedure, using minimal invasive technique while operating, short or no fasting period, use of regional anesthesia and opioid-sparing analgesia, early postoperative intake of food and mobilization, minimum use of fluid, surgical tubes and drains. Different studies have shown that implementation of enhance recovery after surgery protocols in different adult surgical procedures has reduced the length of stay of patients in hospitals, helps them in fast recovery and, it is cost effective.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe rationale of this study is to highlight the outcome of enhanced recovery protocol after gut anastomosis in pediatric population. There is limited literature on enhanced recovery protocol for pediatric surgery. Various studies have been published discussing the use of this protocol in adult surgery but recently this protocol has been in use by pediatric surgery. According to study of Ghufran S. et all from Egypt mean hospital stay after application of ERAS protocol was 4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69.\u003csup\u003e5\u003c/sup\u003e According to a study by Fathy M. et all, patients treated with an enhanced recovery protocol had mean length of postoperative stay of 4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 days as compared to 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05 days.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eIt was Prospective Descriptive case series done at the Department of Pediatric Surgery, Children\u0026rsquo;s Hospital and The University of Child Health Sciences, Lahore, Pakistan. The \u003cb\u003es\u003c/b\u003etudy was conducted over a period of 6 months after the approval of IRB from 3-03-2024 to 3-09-2024.A sample size of 100 cases was calculated using 95% confidence level using anticipated percentage of anastomosis leakage as 8.6% (5) with 5.5% margin of error. Data was collected from the children aged 1 month to 14 years undergoing gut anastomosis surgeries admitted in surgical department of Children Hospital Lahore. A Proforma including consent form was prepared and finalized by pre-testing. Information collected on demography, age, sex, diagnosis, previous surgery, type of surgery (elective or emergency), time of full feed and whether anastomosis leaked or not.\u003c/p\u003e \u003cp\u003eAttendants of patients undergoing gut anastomosis were counselled regarding disease, surgical procedure and consent was signed. High carbohydrate containing fluids (4 table spoons of Galaxose-D or simple sugar in 1liter water, juice, Rooh afza) was given till 4hours before surgery in elective surgery. Nasogastric tube and Foley\u0026rsquo;s catheter were avoided or removed and oral sips were allowed within 24 hours of surgery. Patient was discharged as soon as regular oral feed is established and patient passes stool or flatus. Proformas were filled at the time of discharge.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cp\u003eThe collected data was checked by using computer software SPSS (Statistical Package for Social Sciences) version 22.0 and analyzed with same software. Data was represented in mean and standard deviation (SD) for quantitative data e.g., age and length of hospital stay and in terms of frequency for categorical data e.g., gender, type of surgery. Pearson correlation coefficients were calculated to assess the strength of linear relationships between paired numerical variables and outliers were identified through IQR method.\u003c/p\u003e \u003cp\u003eData was stratified for age, gender, diagnosis and type of surgery. Chi-square test was applied for leakage. P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as significant. Binary logistic regression test was applied to assess the effect of length of stay, time to establish feed, time to remove nasogastric tube and foleys\u0026rsquo;s catheter and time to start oral sips on the outcome of ERAS Protocol.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1; summarize the patient\u0026rsquo;s demographics and clinical details. The median age was 4.59 \u0026plusmn; 2.64 years with minimum of 01 month and maximum 14 years\u0026rsquo; age. Mean weight calculated was 14.55\u0026plusmn;8.6 kilograms. A strong correlation was observed between age and weight (0.87) suggestive of normal increased weight with age. In our study 64% were male patients and 36% were female. Male to female ratio is 1.8: 1. \u0026nbsp;63% patients underwent elective surgery and 37% had emergency surgery. 49% were admitted for enterostomy closure and 51% underwent laparotomy with anastomosis. \u0026nbsp; Among them 32% underwent gut anastomosis in first surgery while rest were previously operated and most of them had enterostomy made in previous surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMean length of hospital stay calculated was 4.63 \u0026plusmn;2.49 days with minimum 1 day and outlier 10-18 days. The mean time to start full feed was 3.36\u0026plusmn;2.0 days with minimum 0.5 days duration. Length of stay had positive correlation with time to establish full feed (0.83) indicating longer stay in patients who took longer time to start full solid feed. Mean time to remove nasogastric tube was 11.7\u0026plusmn;11.2 hours with few patients in whom nasogastric tube was not inserted, mean time to remove Foley\u0026rsquo;s catheter was 15.1\u0026plusmn;9.90 hours and mean time to start clear fluids was 11.5\u0026plusmn;6.6 hours (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Only 8% patients suffered from wound infection after surgery but wound infection had a negative correlation with length of stay and time to start full feed. 6% patients developed anastomosis leak after surgery with mean of 6\u003csup\u003eth\u003c/sup\u003e day of anastomosis. It had negative correlation index (-0.6) with length of stay and time to start full feed. \u0026nbsp;Children in younger age group had significantly higher hospital stay and complications rate as compared to children in elder age group i.e., 4.91 vs. 3.70 days, (P=0.040) implying ERAS Protocol needs to be modified for the infants. Chi square test applied for anastomosis leak and wound infection showed significant p-value while for age stratification and diagnosis it was insignificant.\u003c/p\u003e\n\u003cp\u003eA binary logistic regression was performed to ascertain the effect of hospital stay, full feed time, time to start oral sips, time to remove nasogastric tube and foley\u0026rsquo;s catheter on the likelihood of uneventful outcome and it came out to be significant p\u0026lt;0.00. Model explained 38.5% of the variance. Full feed time showed twice the likelihood to have uneventful outcome and was statistically significant (p=0.017) but statistically non-significant likelihood for the rest of the variables, indicating that the earlier feeding is the most potent component of ERAS Protocol (Table 3).\u003c/p\u003e\n\u003cp\u003eBesides wound infection and anastomosis leak, various other minor complications were observed including vomiting (7%), abdominal distention (4%), electrolyte imbalance (1%) and phimosis (1%) which were more common in colostomy reversal, gut tumor resection and strangulated inguinal hernias with significant p-value.\u003c/p\u003e\n\u003cp\u003eOverall 78% had uneventful outcome with ERAS Protocol and 22% of patients had minor and major complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Patient\u0026rsquo;s demographics and clinical details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables n=100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003eMean = 4.596 \u003cu\u003e+\u003c/u\u003e\u0026nbsp; \u0026nbsp;3.64\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026lt; 5years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e66.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e5-10years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e10.1-14years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e64.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 179px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003cp\u003eMean=14.55 \u003cu\u003e+\u003c/u\u003e 8.64\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026lt; 10 Kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e11 - 22 Kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e53.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e23 - 45 Kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eHemoglobin Level mg/dl\u003c/p\u003e\n \u003cp\u003eMean = 10.83 \u003cu\u003e+\u003c/u\u003e\u0026nbsp; \u0026nbsp;2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eLow (\u0026lt; 11.0 mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e64.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eNormal (\u0026gt; 11.0 mg /dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eRedo Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e63.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eWound infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAnastamotic leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e94.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eGood outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e78.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eFailure / poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Mean hospital stay among subjects:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital \u0026nbsp; \u0026nbsp; stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime to establish full feed (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime to remove NG (hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime to remove Foley (hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime to start oral sips (hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3.3550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e11.7000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e15.1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e11.5700\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2.00416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e11.26315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e9.91937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6.69276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e14.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e48.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e48.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e24.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Binary logistic regression model of ERAS outcome with hospital stay, feed time, time to remove NG, Foley and start oral sips:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"640\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 640px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables in the Equation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eS.E.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eExp(B)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 63px;\"\u003e\n \u003cp\u003eStep 1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eHospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.309\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eFeed time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e5.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.393\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eTime to remove NG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e-.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.941\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eTime to remove Foley\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eTime to start oral sips\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e-5.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e15.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 640px;\"\u003e\n \u003cp\u003ea. Variable(s) entered on step 1: hospital stay, feed time, time to remove NG, foley, and start oral sips.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eEnhanced Recovery After Surgery (ERAS) protocols have gained significant attention in recent years for their potential to optimize perioperative care and improve outcomes in surgical patients. Initially developed for adult patients, ERAS protocols are now being adapted and implemented in pediatric populations undergoing various surgical procedures, including gut surgeries. \u003csup\u003e3\u003c/sup\u003eThe ERAS approach is a multidisciplinary perioperative care pathway designed to minimize surgical stress, reduce complications, and facilitate early recovery.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e It encompasses a comprehensive set of evidence based perioperative interventions and principles aimed at enhancing patient outcomes and expediting recovery.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe findings of our study shed light on the application of the Enhanced Recovery After Surgery (ERAS) protocol in pediatric patients undergoing gut anastomosis. Our analysis revealed a mean age of patients undergoing these procedures to be 4.59 years, with a predominance of males (64%) compared to females (36%). This demographic distribution is consistent with previous studies in pediatric surgical populations.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In a study on pediatric population undergoing gut surgery mean age recorded was 3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1years, and\u003c/p\u003e \u003cp\u003emore male as compared to female patients (163 versus 115).\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNotably, the majority of patients in our study had colostomy reversal (26%), followed by ileostomy reversal (21%) and intussusception (13%). These findings underscore the diverse spectrum of gut surgeries encountered in pediatric practice and highlight the relevance of implementing standardized perioperative care pathways, such as ERAS, across various surgical procedures. The causes of gastrointestinal surgery in children reported include, Meckel's diverticulum with band causing obstruction, obstructed inguinal hernia, postoperative adhesions, congenital peritoneal bands, Hirschsprung's disease, abdominal tuberculosis, typhoid ileal perforation, and umbilical hernia. Acute appendicitis is also a common cause, except in the infancy period where congenital abnormalities predominate. Gastroschisis, midgut volvulus, and abdominal trauma are other indications\u003c/p\u003e \u003cp\u003efor lower gastrointestinal surgery in children.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur study also evaluated key clinical outcomes following the implementation of the ERAS protocol. The mean length of hospital stay was 4.63 days, reflecting findings consistent with other similar studies conducted internationally. According to metanalysis including papers from developed countries length of stay reduced to 2.04\u0026ndash;7.7 days in ERAS group\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and being a LMIC 4.63 days stay corresponds to developed countries reducing economic burden on health facilities. Similarly, one meta-analysis showed that Enhanced Recovery After Surgery (ERAS) in pediatric abdominal surgery resulted in reduced length of hospital stay (MD -1.96), time to oral intake (MD -3.37), and time to stool (MD -4.19). ERAS also reduced postoperative complications by 50% and 30-day readmissions by 36%.\u003csup\u003e3\u003c/sup\u003e ERAS implementation as a bundle led to improved postoperative outcomes, including a statistically significant reduction in the rate of postoperative complications by 50% and a 36% reduction in 30-day readmission.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn terms of postoperative complications, our analysis revealed a low incidence of wound infection (8%) and anastomosis leak (6%) in our study population which is consistent with other studies. In recent RCT, the postoperative complication rate noted was significantly lower in the enhanced recovery after surgery (ERAS) group compared to the non-ERAS group (29.6% vs. 55%, p\u0026thinsp;=\u0026thinsp;0.049).\u003csup\u003e13\u003c/sup\u003e Another meta-analysis showed that the use of Enhanced Recovery After Surgery (ERAS) protocols in gastrointestinal surgery resulted in a decrease in the incidence of lung infection (risk ratio\u0026thinsp;=\u0026thinsp;0.46, 95% confidence interval 0.27\u0026ndash;0.74, P\u0026thinsp;=\u0026thinsp;.002). ERAS protocols also led to a significant reduction in the length of hospitalization after surgery. However, the ERAS protocol groups had higher readmission rates, as well as increased rates of nausea and vomiting. Contrast, to our results in this review there was no significant difference noted in the incidence of anastomotic leakage, ileus, surgical site infection.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn conclusion, our study highlights the successful implementation of the Enhanced Recovery After Surgery (ERAS) protocol in pediatric patients undergoing gut anastomosis surgeries at Children's Hospital Lahore. Our findings support the effectiveness of the ERAS protocol in terms of reducing length of postoperative hospital stay and incidence of complications including anastomosis leakage and wound infection. However, infants do not respond much to ERAS Protocol as compared to children above 1 years.\u003c/p\u003e\n\u003ch3\u003eResults\u003c/h3\u003e\n\u003cp\u003eERAS Protocol is an effective modality for pediatric gut anastomosis in low middle income countries resulting in earlier postoperative recovery, reduced length of stay and reduced incidence of complications with complete effectiveness in 78% patients. However, ERAS Protocol needs to modified for infants.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM and N made contributions to the conception or design of the work, acquisition, analysis and interpretation of data.M, H, Z and W collected data by implementing the ERAS Protocol, analyzed and interpreted the data.N and F drafted the work and analyzed it critically for important intellectual content. N, H, Z, W and F approved the version to be published.M and Z agree to be accountable for all aspects of work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRoberts K, Brindle M, McLuckie D. Enhanced recovery after surgery in paediatrics: a review of the literature. BJA education. 2020;20(7):235-41.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHoffmann H, Kettelhack C. Fast-track surgery\u0026ndash;conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. ESR. 2012;49(1):24-34.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRove K, Brockel M, Saltzman A, D\u0026ouml;nmez M, Brodie K, Chalmers D, et al. Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations. JPU. 2018;14(3):252. e1-. e9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVargus M, Sardaneta M, Reyes D, Justo-Janeiro J. Intestinal anastomosis. Clin Surg. 2018;3:1854-6.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGhufran S, Janjua AA, Chaudary SM, Munawwar F, Hassan M, Changazi SH. Outcome of Enhanced Recovery After Surgery Protocols in Patients Undergoing Small Bowel Surgery. Cureus. 2020;12(10).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRove KO, Edney JC, Brockel MA. Enhanced recovery after surgery in children: Promising, evidence‐based multidisciplinary care.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePediatric Anesthesia. 2018;28(6):482-92.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRaval MV, Heiss KF. Development of an enhanced recovery protocol for children undergoing gastrointestinal surgery. Current opinion in pediatrics. 2018;30(3):399-404.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFathy M, Khedre M, Nagaty M, Zaghloul M. Enhanced recovery protocol vs traditional methods after resection and reanastomosis in gastrointestinal surgery in pediatric patients. AOPS 2018; 14(4):214-\u003c/li\u003e\n \u003cli\u003ePatil S, Cornett E, Jesunathadas J, et al. Implementing enhanced recovery pathways to improve surgical outcomes. J Anaesthesiol Clin Pharmacol 2019;35:S24-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations \u0026mdash; 2019 update. Int J Gynecol Cancer 2019. Mar. 15 [Epub ahead of print].\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShang Q, Geng Q, Zhang X, Xu H, Guo C. The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis. Medicine (Baltimore). 2018 ;97(9):e0045.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShang Q, Geng Q, Zhang X, Xu H, Guo C. The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis. Medicine (Baltimore). 2018 ;97(9):e0045.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDipasquale V, Lagan\u0026agrave; F, Arrigo S, Trimarchi G, Romeo C, Navarra G, Mattioli G, et al. Enhanced Recovery Care versus Traditional Care after Surgery in Pediatric Patients with Inflammatory Bowel Disease: A Retrospective Case-Control Study. Biomedicines. 2022; 10(9):2209. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFeng JY, Wang SF, Yan J. The Application of Enhanced Recovery After Surgery for Gastrectomy and Colorectal Resection: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A. 2023 ;33(6):586-595. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGrass F, H\u0026uuml;bner M, Demartines N, Hahnloser D.Chirurgie du cancer du c\u0026ocirc;lon en 2021 [Surgery for colon cancer in 2021] https://pubmed.ncbi.nlm.nih.gov/34133092/ Rev Med Suisse. 2021;17:1155\u0026ndash;8..\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEllis CT, Maykel JA. Defining anastomotic leak and the clinical relevance of leaks. Clinics in Colon and Rectal Surgery. 2021 Oct 1;34(06):359-65.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePandiaraja J, Chakkarapani R, Arumugam S. A study on patterns, indications, and complications of an enteric stoma. J Family Med Prim Care. 2021 ;10(9):3277-3282.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBrindle M.E. Heiss Scott M.J. Herndon C.A. Ljungqvist O. Koyle M.A. Embracing change: the era for pediatric ERAS is here. Pediatr Surg Int. 2019; 35: 631-634\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRafeeqi T, Pearson EG. Enhanced recovery after surgery in children. Transl Gastroenterol Hepatol. 2021 Jul 25;6:46.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSanford E.L. Zurakowski D. Litvinova A. Zalieckas J.M. Cravero J.P. The association between high-volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection. Paediatr Anaesth. 2019; 29: 315-21.\u003c/li\u003e\n \u003cli\u003eLi WTV, Li WK, Chan YC, Cheung TY, Su CK, Tan QXR, Wong TH, Chung PHY. Enhanced Recovery After Surgery in paediatric patients undergoing gastrointestinal surgeries- A scoping review. JPS. 2023 Apr;1\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ERAS, Gut Anastomosis, Pediatric Population","lastPublishedDoi":"10.21203/rs.3.rs-8583890/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8583890/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND\u003c/h2\u003e \u003cp\u003eERAS protocols are comprehensive perioperative care plans designed to facilitate swift recovery. This study is focused on ERAS in pediatric gut anastomosis and contributes valuable insights to perioperative care, with potential implications for future practices.\u003c/p\u003e\u003ch2\u003eMATERIAL AND METHOD:\u003c/h2\u003e \u003cp\u003eThis study was conducted after approval from IRB, on 100 patients undergoing gut anastomosis. ERAS protocol was applied on all patients. Patients were observed for duration of postoperative hospital stay, wound infection and anastomosis leak. Data was analyzed using SPSS v22.0. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for continuous variables and frequency for categorical variables. Pearson correlation coefficients were calculated to assess the strength of linear relationships between paired numerical variables and binary logistic regression test was performed between outcome and various variables.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eMean age of patients calculated was 4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64 years. Mean length of hospital stay calculated was 4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49 days. Only 8% patients suffered from wound infection and 6% patients developed anastomosis leak after surgery. Overall ERAS Protocol was effective in 78% patients and had significant p-value for the time to establish full feed.\u003c/p\u003e\u003ch2\u003eCONCLUSIONS\u003c/h2\u003e \u003cp\u003eThe implementation of an ERAS protocol in pediatric patients undergoing gut anastomosis demonstrates promising results in terms of reducing the length of hospital stay and potentially lowering the risk of postoperative complications.\u003c/p\u003e","manuscriptTitle":"Outcomes of Enhanced Recovery After Surgery (Eras) Protocol After Gut Anastomosis in Paediatric Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 06:54:34","doi":"10.21203/rs.3.rs-8583890/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"feba3f1a-11ab-40ea-b4a2-e0fde0fa4291","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T23:53:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 06:54:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8583890","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8583890","identity":"rs-8583890","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}