| Objective: The concept of enhanced recovery after surgery（ERAS）was applied to the perioperative care model of pediatric acute appendicitis treated by laparoscopic technique,and the safety,feasibility and effectiveness of the ERAS concept in the perioperative period of pediatric acute appendicitis were investigated by comparing it with the traditional perioperative care model.Methods: A non-randomized,concurrently controlled study was conducted to select 116 children with acute appendicitis treated by minimally invasive laparoscopic surgery in the Department of Pediatric Surgery,Affiliated Hospital of Jining Medical University,Shandong Province,China,from September 2020 to October 2021.Among them,54 cases were set as ERAS group after obtaining their parents’ informed consent,62 were set as control group.General data were collected: age,sex,body mass index,temperature,heart rate,blood pressure,Alvarado score,ASA score;preoperative laboratory indices: leukocytes,C-reactive protein,hemoglobin,albumin,platelets,and biochemical indices of sodium,potassium,chloride,and bicarbonate;intraoperative observation indices:intraoperative bleeding,intraoperative fluid volume,and operative time;postoperative pathotyping;postoperative inflammation indices;postoperative observation indexes: time of first gas,time of getting out of bed,pain score,hospitalization time,hospitalization cost,satisfaction of children and parents,nausea and vomiting,incisional infection,residual abdominal infection,readmission,reoperation,intestinal obstruction.The above observed indexes of the two groups of children were analyzed for differences between groups,and logistic regression analysis was used to conduct multifactorial analysis of postoperative complications to find factors that had an independent effect on the occurrence of postoperative complications.Results: Preoperative and intraoperative data: there was no statistical difference between the ERAS group and the control children in general data,preoperative inflammatory indexes,routine laboratory tests,intraoperative bleeding volume,intraoperative infusion volume and operation time（P>0.05）.Postoperative data: postoperative inflammatory indexes: C-reactive protein at 3 days after surgery,leukocytes at 3 days after surgery and discharge C-reactive protein in the ERAS group were lower than those in the control group,and the difference was statistically significant（P<0.05）.There was no statistically significant difference between the two groups of children with discharge leukocytes and postoperative pathological staging（P>0.05）.Postoperative observation indexes: the ERAS group was significantly better than the control group in terms of time to first exhaustion,time to bed activity,pain score,length of hospital stay,hospital expenses,satisfaction of children and parents,nausea and vomiting,and the difference was statistically significant（P<0.05）.Compared with the control group,there was no statistically significant difference in incisional infection,residual abdominal infection,readmission and intestinal obstruction in the ERAS group（P>0.05）,but the number of cases of the above-mentioned postoperative adverse reactions and complications in children in the ERAS group was significantly less than that in the control group.Multi-factor logistic regression analysis did not find any relevant risk factors that significantly influenced the occurrence of postoperative complications.Conclusion: The application of the enhanced recovery after surgery concept in the perioperative care model of pediatric acute appendicitis treated with laparoscopic technology is safe,effective,feasible,and can significantly improve the recovery time of the child’s gastrointestinal function,improve the child’s pain,reduce hospital costs,shorten the postoperative hospital stay,reduce some postoperative complications,improve the satisfaction of the child and parents,and accelerate the child’s postoperative recovery. |
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