Fast track in paediatric surgery: enhanced recovery after surgery for thoracoscopic lung resections in infants

Introduction
Fast-track thoracic surgery is a new global perioperative management that leads to, and achieves, early recovery of the patient. Enhanced recovery after surgery (ERAS) programs represent an important clinical approach; however, these programs are not widely adapted to surgery in small children. The objective of this study was the analysis of infants and children under two years of age who had undergone an operation for congenital pulmonary malformations, regarding the possibility of fast-track thoracic surgery with the approach of ERAS programs.

Material and methods
A total of 11 children diagnosed for extra-lobar sequestration (ELS, n = 3), congenital pulmonary adenomatoid malformation (CPAM, n = 2), intra-lobar sequestration (ILS, n = 2), hybrid lesions (ILS + CPAM, n = 2; ILS + bronchial cyst, n = 1), or ELS with congenital diaphragmatic eventration (n = 1) were analysed according to the ERAS protocol.

Results
Two groups of patients were identified with differences in hospital length of stay (LOS) and the need of postoperative treatment. The median LOS was three and five days, respectively. Infants in group I had higher body weight (median: 9.9 vs. 8 kg). The complexity of the procedure (ELS removal vs. other), the length of the surgical procedure (mean operative time: 117 min vs. 190 min), use of postoperative chest tube (1 vs. 3.5 days), and the need for, or length of, Intensive Care Unit stay (median: 0 vs. 2 days) had an impact on the postoperative course and the possibility of shorter hospital stay.

Conclusions
ERAS protocol was feasible for both analysed groups of infants and small children after uncomplicated thoracoscopic surgery. Using a multidisciplinary team is a key factor to achieve success in enhanced recovery, including good compliance with the parents. Fast track in paediatric surgery results in shorter LOS and decreased stress for the child and the family.