A Modified Enhanced Recovery After Surgery Protocol Versus Standard Care in Pediatric Major Gastrointestinal Surgery: A Randomized Controlled Trial

Background Perioperative management in pediatric major gastrointestinal surgery often involves prolonged fasting, delayed mobilization, and invasive monitoring, which may increase stress responses and slow recovery. Enhanced recovery after surgery (ERAS) pathways are well established in adults but require pediatric adaptation. This study evaluated a modified ERAS protocol versus standard care in pediatric patients undergoing major gastrointestinal surgery. Methodology This single-blind randomized controlled trial enrolled pediatric patients aged two months to five years undergoing major gastrointestinal surgery. Participants were randomized to a modified ERAS group (n = 40) or standard care group (n = 42). Outcomes included time to first oral nutrition, time to first mobilization, time to urinary catheter removal, length of hospital stay, and intraoperative glucose and electrolyte levels. Results Early mobilization was significantly faster in the modified ERAS group (p = 0.014), and length of hospital stay was shorter (p = 0.018). The modified ERAS group demonstrated lower intraoperative glucose levels at later intraoperative timepoints (timepoint 2, p = 0.047; timepoint 3, p = 0.008). There were no significant differences in time to first oral nutrition, urinary catheter removal, or intraoperative electrolyte levels between groups. Conclusions A modified ERAS protocol in pediatric major gastrointestinal surgery was associated with earlier mobilization, shorter hospitalization, and improved intraoperative glucose stability compared with standard care. Adoption of pediatric-adapted ERAS pathways may improve perioperative outcomes in this population.