An enhanced recovery after surgery for the Nuss procedure for pectus excavatum in pediatric patients in Shanghai.

AIMS: This study aimed to implement and evaluate an enhanced recovery after surgery pathway for pediatric patients undergoing the Nuss procedure.

METHODS

The enhanced recovery after surgery pathway was implemented in 2024, and this protocol included preoperative education and counseling, a perioperative multimodal pain management protocol, a perioperative staged rehabilitation exercise program, and predischarge education. Data were collected prospectively for patients in the ERAS pathway and retrospectively for previous patients. Length of stay (LOS) and activity of daily living (the Barthel Index) were the main outcomes of this study, and the pain scores and time to first ambulation postoperatively were the secondary outcomes.

RESULTS

A total of 86 patients were included in this study, with 43 patients in each group. There was no significant difference in age, sex, or the Haller index between the two groups. The average LOS decreased from 7.74 days to 6.84 days with ERAS. Patients in the ERAS group had improved Barthel indices, particularly on the day of discharge, and significantly lower pain scores from POD0 to POD3. The time to first ambulation was also shorter in the ERAS group.

CONCLUSION

An enhanced recovery after surgery procedure implemented for the Nuss procedure can reduce the length of stay and early pain score. Alterations in the pathway may lead to the achievement of the desired goals of better self-care ability in daily living.

CLINICAL TRIAL NUMBER: Not applicable.