Efficacy and safety of an abbreviated perioperative care bundle versus standard perioperative care in children undergoing elective bowel anastomoses: A randomized, noninferiority trial

• Published in: Journal of pediatric surgery Vol. 55; no. 10; pp. 2042 - 2047
• Main Authors: Santos-Jasso, Karla A., Lezama-Del Valle, Pablo, Arredondo-Garcia, Jose L., García-De la Puente, Silvestre, Martinez-Garcia, Maria C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2020
• Subjects: Anastomosis, Surgical - methods; Antibiotic prophylaxis in bowel anastomosis; Bowel anastomosis; Child; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - methods; Early feeding after; Elective Surgical Procedures; Humans; Mechanical bowel preparation; Ostomy closure; Patient Care Bundles - adverse effects; Patient Care Bundles - methods; Pediatric colorectal surgery; Perioperative Care - adverse effects; Perioperative Care - methods; Postoperative Complications; Ostomy closure; Mechanical bowel preparation; Bowel anastomosis; Pediatric colorectal surgery; Antibiotic prophylaxis in bowel anastomosis; Early feeding after
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2019.12.010

The aim was to evaluate if an abbreviated perioperative care bundle (APCB) is noninferior to the standard care, in terms of efficacy and safety, in pediatric patients undergoing bowel anastomoses. A randomized, open, noninferiority trial with two parallel groups of equal size was carried out at the National Institute of Pediatrics in Mexico City, Mexico, from April 2016 to July 2018. The total number analyzed was 74 (37 per group). The APCB comprised same day admission, avoidance of mechanical bowel preparation, optimized antibiotic prophylaxis, and early feeding. Statistical analysis was done with Fisher's exact test or Chi2, and Student's T test. No significant differences were found for demographic variables and type of disease, either for the safety (anastomotic leakage, p 0.753; organ/space surgical site infection, p 0.500) or for some efficacy outcomes (ileus or bowel obstruction, p 0.693). Other efficacy outcomes were better in the study group, with shorter median times for feeding tolerance (19 h vs. 92 h, p < 0.001), for first bowel movement (15 h vs. 36 h, p < 0.001), and for discharge (1 vs. 6 days, p < 0.001). The abbreviated care bundle was proven to be as safe but more efficacious than the standard care. I — randomized controlled trial with adequate statistical power.