Enhanced recovery after surgery in pediatric orthopedics (ERAS-PO)

Abstract

"Enhanced recovery after surgery" is now the official term: ERAS. Patients come to a specialized center for surgery, and early recovery is ensured by minimizing the impact of surgical stress, controlling pain and stimulating autonomy. Patient information and education concerning the process and care organization enable short hospital stay with early discharge. The expected benefits are fewer postoperative complications and shorter hospital stay. There is nothing to prevent this kind of program being implanted for children, so long as age and the parent-child relationship are taken into account. Lessons should be drawn from existing pediatric therapeutic education programs, to adapt information and training to the child's cognitive, motor and psycho-affective development. Setting up an ERAS program is the result firstly of medical and surgical reflection. All healthcare actors need to be actively involved, to set up a management program for the parent-child duo. Implementation, monitoring and assessment are the responsibilities of the physicians who initiate the program. Fewer postoperative complications, with earlier discharge and rehabilitation, should reduce costs and improve patient management in hospital. Such is, indeed, usually the case, but unfortunately drastic health expenditure curbs greatly attenuate the expected benefit in terms of care organization and cost savings.

Keywords: Cost-effectiveness analysis; Enhanced recovery after surgery; Parent-child duo; Therapeutic education.