Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma

Infographic · Mar 2026 · 1 min read

In brief

Multi-center study demonstrates ERAS protocol significantly reduces hospital stay from 6.9 to 3.7 days and complications from 96% to 39% in children undergoing abdominal neuroblastoma resection. Protocol achieved earlier diet advancement, reduced opioid use by 61%, and nearly eliminated nasogastric tube dependency.

ERAS protocol reduced post-op complications from 96% to 39% in pediatric neuroblastoma resection patients
Length of stay decreased by 3.2 days (6.9 to 3.7 days) with ERAS implementation across three children's hospitals
Post-operative opioid use cut by 61% (0.54 to 0.21 MME mg/kg/day) with ERAS pathway
ERAS patients advanced to regular diet and ambulated 3 days earlier than pre-ERAS cohort
Nasogastric tube use dropped from 92% to 17% post-operatively with standardized ERAS protocol

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, accompanied by bullet-pointed text describing outcomes. The left column shows balloon dilation, the middle shows Heller myotomy, and the right shows POEM procedure. Success rates are prominently displayed with percentage figures.

Sara A Mansfield, Meera Kotagal, Stephen J Hartman, Andrew J Murphy, Brady Hogan, Darren Ha, Doralina L Anghelescu, Marc Mecoli, Nicholas G Cost, Andrew M Davidoff, Kyle O Rove

Background: Enhanced recovery after surgery (ERAS) pathways are multidisciplinary strategies to return patients to their physiologic baseline as efficiently as possible. This study aims to evaluate the feasibility and benefits of an ERAS pathway in children undergoing resection of abdominal neuroblastoma.

Methods: After IRB approval, all patients greater than 1 month old undergoing resection of an abdominal neuroblastoma at one of three children's hospitals between 2020 and 2022 were offered enrollment. A standardized ERAS protocol was utilized at all institutions. Data were prospectively recorded. We compared the prospective cohort to a historic cohort (2014-2020). Fisher's exact and t-tests were used, as appropriate.

Results: The study included 23 patients in the ERAS group compared to 24 historic patients. Post-operative nasogastric tube use decreased from 91.7% pre-ERAS to 16.7% in the ERAS cohort. ERAS patients were advanced to regular diets and ambulated 3 days earlier than pre-ERAS. Post-operative opioid consumption decreased from 0.54 to 0.21 milligram morphine equivalents (MME) mg/kg/day (p = 0.047). All but one patient (23, 96%) in the pre-ERAS cohort experienced at least one post-operative complication, compared to only nine (39.1%) in the ERAS cohort (p < 0.001). Average length of stay was 3.7 days with ERAS compared to 6.9 days pre-ERAS (p = 0.004).

Discussion: ERAS is associated with improvements in length of stay and a decrease in complications following resection of abdominal neuroblastoma. Children with neuroblastoma stand to benefit considerably from the benefits associated with the use of an ERAS protocol, given their intensive treatment, complex surgeries, and need for expeditious recovery.

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