Outcomes After Implementation of an Enhanced Recovery Protocol for Minimally Invasive Repair of Pectus Excavatum

Background: Surgical repair of pectus excavatum is commonly associated with significant post-operative pain requiring prolonged hospital stays and critical care admission for sedative and analgesic infusions. By implementing an enhanced recovery after surgery (ERAS) protocol for patients undergoing minimally invasive pectus repair, we aimed to reduce length of hospital stay, need for higher level monitored care, and opioid utilization. Methods: A retrospective chart review was performed for all patients under the age of 25 years who underwent Nuss bar insertion at our institution between January 2011 and May 2021. The primary outcomes were hospital length of stay, intensive care unit (ICU) utilization, and opioid consumption before and after the implementation of the ERAS protocol in December 2017. Results: A total of 86 patients underwent Nuss repair of pectus excavatum, including 14 patients in the ERAS cohort. Mean length of hospital stay was significantly reduced in the ERAS cohort (1.9 vs. 4.9 days, P < 0.001). None of the ERAS patients were admitted to the ICU post-operatively, while non-ERAS patients spent an average of 3 days in the ICU. Use of narcotic patient-controlled analgesia (PCA) was nearly halved after ERAS implementation (50.0% vs. 97.2%), and total oxycodone, Percocet, and Dilaudid dosages were significantly reduced. Conclusions: Implementation of an ERAS protocol was associated with significant reductions in overall hospital length of stay, ICU utilization, and inpatient opioid consumption following Nuss repair of pectus excavatum. These changes in post-op management are expected to reduce costs and promote earlier return to school and activities.