Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countries
Introduction: Enhanced Recovery After Surgery guidelines have been developed and shown to improve outcomes for many surgical procedures. Most existing guidelines have been created for patients in high-resource settings. There is a dearth of guidelines for pediatric populations particularly in low- a...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Journal of Pediatric Surgery Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949711623000679 |
| _version_ | 1797398346617323520 |
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| author | Mercedes Pilkington Mary E. Brindle Godfrey Sama Philipo |
| author_facet | Mercedes Pilkington Mary E. Brindle Godfrey Sama Philipo |
| author_sort | Mercedes Pilkington |
| collection | DOAJ |
| description | Introduction: Enhanced Recovery After Surgery guidelines have been developed and shown to improve outcomes for many surgical procedures. Most existing guidelines have been created for patients in high-resource settings. There is a dearth of guidelines for pediatric populations particularly in low- and middle-income countries (LMIC). All children with Wilms tumours require resection for cure and therefore a perioperative care pathway can streamline care for all curative-intent nephrectomies. Methods: A two-round Delphi consensus of clinicians in LMICs was utilized to determine the scope and content of recommendations for an enhanced recovery protocol for children with Wilms tumours undergoing nephrectomy in LMICs. Consensus was predefined a priori as ≥70% of panelists indicating a topic or recommendation should be included. Results: Twenty-six topics met consensus for inclusion and were consolidated into twenty recommendations for implementation in the preoperative, intraoperative, and postoperative setting. Predominant themes included perioperative nutrition, surgical safety, anesthetic concerns, and interdisciplinary oncology care. Ten participants completed round one and six completed round two. All recommendations met consensus for inclusion after two rounds. Conclusions: A consensus-derived perioperative care pathway for children with Wilms tumours in low-resource settings is presented. Recommendations share many priorities with high-resource pathways, but also contain unique considerations for a low-resource setting. |
| first_indexed | 2024-03-09T01:24:19Z |
| format | Article |
| id | doaj.art-5778024edc3c4cb2aa095f5203a6f7f5 |
| institution | Directory Open Access Journal |
| issn | 2949-7116 |
| language | English |
| last_indexed | 2024-03-09T01:24:19Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Open |
| spelling | doaj.art-5778024edc3c4cb2aa095f5203a6f7f52023-12-10T06:19:52ZengElsevierJournal of Pediatric Surgery Open2949-71162023-12-014100070Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countriesMercedes Pilkington0Mary E. Brindle1Godfrey Sama Philipo2Division of Pediatric General and Thoracic Surgery, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5 X 1G8; Corresponding author.Division of Pediatric Surgery, University of Calgary, 28 Oki Dr NW, Calgary, Canada, T3B 6A8The College of East Southern and Central Africa (COSECSA), 157 Olorien, Njiro Road ECSA-HC P.O. Box 1009 Arusha, TanzaniaIntroduction: Enhanced Recovery After Surgery guidelines have been developed and shown to improve outcomes for many surgical procedures. Most existing guidelines have been created for patients in high-resource settings. There is a dearth of guidelines for pediatric populations particularly in low- and middle-income countries (LMIC). All children with Wilms tumours require resection for cure and therefore a perioperative care pathway can streamline care for all curative-intent nephrectomies. Methods: A two-round Delphi consensus of clinicians in LMICs was utilized to determine the scope and content of recommendations for an enhanced recovery protocol for children with Wilms tumours undergoing nephrectomy in LMICs. Consensus was predefined a priori as ≥70% of panelists indicating a topic or recommendation should be included. Results: Twenty-six topics met consensus for inclusion and were consolidated into twenty recommendations for implementation in the preoperative, intraoperative, and postoperative setting. Predominant themes included perioperative nutrition, surgical safety, anesthetic concerns, and interdisciplinary oncology care. Ten participants completed round one and six completed round two. All recommendations met consensus for inclusion after two rounds. Conclusions: A consensus-derived perioperative care pathway for children with Wilms tumours in low-resource settings is presented. Recommendations share many priorities with high-resource pathways, but also contain unique considerations for a low-resource setting.http://www.sciencedirect.com/science/article/pii/S2949711623000679Enhanced recovery after surgeryERASPediatricOncologyLMICGlobal surgery |
| spellingShingle | Mercedes Pilkington Mary E. Brindle Godfrey Sama Philipo Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countries Journal of Pediatric Surgery Open Enhanced recovery after surgery ERAS Pediatric Oncology LMIC Global surgery |
| title | Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countries |
| title_full | Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countries |
| title_fullStr | Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countries |
| title_full_unstemmed | Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countries |
| title_short | Creation of an enhanced recovery after surgery protocol for children with Wilms tumours in low- and middle-income countries |
| title_sort | creation of an enhanced recovery after surgery protocol for children with wilms tumours in low and middle income countries |
| topic | Enhanced recovery after surgery ERAS Pediatric Oncology LMIC Global surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2949711623000679 |
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