ERAS (enhanced recovery after surgery) protocol improves recovery in surgical management of pediatric non-cirrhotic portal hypertension: evaluating results of pre and post-ERAS implementation.

PURPOSE: Standardized perioperative pathways for pediatric non-cirrhotic portal hypertension (PHT) requiring complex portosystemic shunt surgery remain scarce. Enhanced Recovery After Surgery (ERAS) protocols aim to reduce surgical stress and optimize postoperative recovery. This study evaluates the impact of ERAS implementation on outcomes in children undergoing shunt procedures for PHT.

METHODS

A retrospective cohort study was conducted over 18 years. Patients were divided into two groups: Group I (pre-ERAS,2006-2016) and Group II (post-ERAS,2016-2024). Demographics, surgical type, time to oral feeding, mobilization, drain usage, ICU stay, hospital stay, and 30-day readmissions were analyzed.

RESULTS

A total of 103 patients (M/F: 50/53; mean age 8.4 ± 5 years) underwent shunt surgery. Fifty-one were treated before and 52 after ERAS implementation. Distal splenorenal shunt was most common (n = 74), followed by Rex shunt (n = 20) and other procedures (n = 9). ERAS was associated with significantly earlier oral feeding (1.1 vs.1.6 days, p = 0.007), earlier mobilization (1.15 vs.1.6 days, p = 0.046), markedly reduced drain use (1.9% vs. 23.5%, p = 0.001), shorter ICU stay (1.48 vs.1.9 days, p = 0.03), and nearly halved hospital stay (4.6 vs.8.5 days, p = 0.001). Thirty-day readmissions were similar.

CONCLUSION

ERAS implementation in pediatric PHT surgery is feasible, safe, and associated with substantially improved recovery and standardized perioperative care.