Enhanced Recovery After Surgery in a Pediatric Thyroid Surgery Oncology Cohort: A 7-Year Retrospective Review

Tuesday, October 1, 2024

10:24 AM – 10:30 AM EDT

Location: MBCC, 244-245

Disclosure(s):

Alisa L. Phillips, MD MSc:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Anthony M. Sheyn, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Enhanced Recovery After Surgery (ERAS) represents a highly effective multidisciplinary pathway demonstrating noteworthy success in recent protocols applied to pediatric patients; there is a notable lack of studies investigating the pediatric thyroid surgery population. The objective of this study is to evaluate clinical outcomes of an ERAS care pathway in a specialized oncology center.

Methods: We performed IRB-approved retrospective chart review from Jan 1, 2016-Sep 30, 2023, of patients with thyroidectomy at a single comprehensive cancer children’s hospital, with 2016 as the control group. The ERAS care pathway emphasized preoperative counseling, pain management with opiate reduction, incision size, calcium protocols, early feeding, and ambulation. Primary outcomes were length of stay (LOS) and readmission.

Results: 95 patients with median age of 16 years [range: 8-22] were identified with 85.9% having thyroid malignancy on final pathology and 38.4% of those being secondary malignancy. The remaining 14.1% of patients were initially concerning on biopsy.

ERAS protocols reduced mean hospital LOS for hemithyroidectomy (mean difference (MD) -0.82 days; 95% confidence interval (95%CI) -0.28 to -1.37 days, p=0.002) with no readmissions in either group.

ERAS protocols decreased post-operative usage of opiates (MD -0.70 MME/kg/day; 95%CI -0.08 to -1.32, p=0.015) without impacting pain scores. Patients who received both scheduled NSAIDs and acetaminophen had improved pain scores (MD -0.93; 95%CI -0.087 to 1.95, p=0.036) with no impact on LOS (p=0.088). Patients who received minimal opiates postoperatively ( < 0.15 MME/kg/day) also had improved pain scores (MD -1.82; 95%CI -0.86 to -2.78, p=0.0001) with no change in LOS (p=0.741). Furthermore, patients were less likely to be discharged home with opiates compared to the control (p < 0.0001, Odds ratio 0.041 [0.005-0.325]).

Conclusions: Implementation of an ERAS protocol in pediatric thyroid surgery oncology cohort is a feasible option to improve pain management while decreasing opiate usage and supports safe same-day discharges for hemithyroidectomy.

Presenting Author(s)

Alisa L. Phillips, MD MSc

Resident
Department of Otolaryngology, Oregon Health & Science University
Portland, OR, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

JL

Jordan B. Luttrell, MD

Resident
Department of Otolaryngology, University of Tennessee Health Science Center College of Medicine
Memphis, TN, United States

Disclosure information not submitted.
LP

Luca Pio, MD

Department of Pediatric Surgery, St. Jude Children's Research Hospital, United States

Disclosure information not submitted.
RW

Regan Williams, MD, MS

Medical Director, Trauma Services; Associate Professor (UTHSC)
Le Bonheur Children's Hospital, University of Tennessee Health Science Center, United States

Disclosure information not submitted.
Anthony M. Sheyn, MD

Division Chief, Pediatric Otolaryngology
LeBonheur Children's Hospital
Memphis, Tennessee, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

CR

Celine C. Richard, MD, PhD

Faculty
UTHSC
Memphis, TN, United States

Disclosure information not submitted.