Standardized pathways cut costs, hospital days in pediatric surgery without raising complication rates

Editor's Note

Standardized perioperative protocols can reduce hospital stays and costs for children undergoing surgery without affecting complication rates, JAMA Surgery August 20 reports. As detailed in this original investigation, the researchers evaluated the Minimizing Variance in Pediatric Surgery (MViPS) program, a fellow-led initiative launched in 2013 across two academic children’s hospitals in Oregon. The program implemented 11 evidence-based clinical pathways covering conditions such as appendicitis, pyloric stenosis, gastroschisis, intussusception, and solid organ injury. The cohort study analyzed outcomes for 1,081 pediatric patients treated between 2012 and 2021.

Complication rates did not differ between groups treated before and after protocol adoption, but measurable resource efficiencies emerged. Patients in the postprotocol group experienced a 23% shorter study length of stay, translating to 191 hospital days saved. Total hospital costs fell 10%, with a calculated reduction of $266,709 during the study period. Scaling these reductions to 3,167 additional patients treated under the protocols after the study window suggests a cumulative savings of $2.2 million and 1,584 hospital days through April 2024. Compliance was high, averaging 82% during the study and 90% in a poststudy audit, with near-perfect adherence for some conditions such as pyloric stenosis and small-bowel obstruction.

The outlet notes improvements were achieved without changes in mortality, readmissions, infections, or reoperations. For example, 30-day postoperative infection rates were identical at 5% for both pre- and postprotocol patients, and readmissions remained at 6% to 8%. These results held across multiple protocols and institutions, reinforcing the program’s scalability and consistency.

MViPS is distinct in scope and structure, per the article. Unlike many Enhanced Recovery After Surgery (ERAS) protocols that focus on single conditions or perioperative stages, MViPS spans the full continuum of care, from diagnosis through postoperative management. Its design as a fellow-led program also provides a framework for training future surgeons in quality improvement and evidence-based care. The authors conclude that widespread adoption of standardized perioperative protocols in pediatric surgery can streamline care delivery, save resources, and preserve safety outcomes, offering a sustainable model for health systems.