Mercedes Pilkington (our MGSC alumni), along with another MGSC alumni, Godfrey Sama Philipo and Mary Brindle, have recently published the results of a study to develop contextually-appropriate enhanced recovery after surgery recommendations for children undergoing resection for Wilms tumours in a low-resource setting.
This study was based on Dr. Pilkington’s final MGSC project as part of SURG 560 Global Surgical Care Field Practicum.
Read the article here.
Read Mercedes’ SURG 560 Final Report here.
Abstract
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.
Keywords
Enhanced recovery after surgery
ERAS
pediatric
oncology
LMIC
global surgery