A Survey on Enhanced Recovery After Surgery (ERAS) Elements in Cleft Palate Repair

Objective This study aims to characterize current use, knowledge, and attitude toward ERAS protocols by academic craniofacial surgeons. Design Craniofacial surgeons were provided with electronic surveys. Setting Electronic survey; Institutional tertiary surgeons. Participants 102 cleft palate surgeons surveyed and 31 completed the survey (30.4%). Interventions None. Main Outcome Measures Respondents rated their knowledge, use, and willingness to implement perioperative interventions modeled after adult ERAS protocols. Results Majority (67.7%) rated they were knowledgeable about ERAS. However, 61.3% "never use" a standardized protocol for cleft palate surgery. Only 3 ERAS elements are currently implemented by a majority of cleft surgeons: avoiding prolonged perioperative fasting (67.7%), using hypothermia prevention measures (74.2%), and minimizing use of opioids (62.5%). A large majority of respondents noted they never administer bolus (71.0%) or infusion (80.6%) dosing of tranexamic acid; most of these surgeons also indicated that administering tranexamic acid "would not be a valuable addition" (67.7% and 71.0%, respectively). Short-acting sedatives are used by 12.9% and by 16.1% of surgeons in all patients during extubation and postoperative recovery, respectively. By contrast, 22.6% never use such agents during extubation and 48.4% never use it during postoperative recovery. Overall, 67.7% of respondents replied that they would be willing to implement an ERAS protocol for cleft palate repair. Conclusions Many respondents report using interventions compatible with an ERAS approach and the majority are willing to implement an ERAS protocol for cleft palate repair.