Physician’s WeeklyQ&A: Pediatric GI Surgery ERP Shows Real‑World Gains Across 18 US Hospitals

🎓 Expert Commentary / Peer Perspective

The ENRICH-US trial evaluated a bundled enhanced recovery protocol in approximately 600 patients aged 10–18 years undergoing GI surgery across 18 US children’s hospitals using a stepped-wedge design. The majority had IBD-related diagnoses. This is the largest prospective implementation trial of its kind in pediatric surgery.

Clinical Considerations

• 56% reduction in inpatient opioid use achieved through multimodal pain management: regional blocks, scheduled non-opioid analgesics, mindfulness tools, and anxiety-targeted interventions
• Patients receiving 13 or more of 21 ERP elements had approximately one day shorter LOS, earlier return to diet, and roughly half the complication risk — threshold adherence drove outcomes more than any single element
• Preoperative carbohydrate loading and IV fluid minimization postoperatively were identified as likely key drivers of faster GI recovery and lower ileus rates
• LOS reduction was not statistically significant in the phase-based analysis; benefit emerged only at the individual patient adherence level

Practice Applications

• Implement ERP as a bundled quality initiative rather than a checklist; aggregate adherence drives measurable outcomes more than individual elements
• Integrate EHR-embedded order sets and reminders to support consistent protocol delivery across the care team
• Recognize preoperative counseling and family engagement as active protocol components requiring patient buy-in, not administrative steps
• Monitor for ileus as a sentinel indicator of IV fluid overload; earlier oral intake and restricted IV fluids appear to reduce incidence