第一部分 超声引导下肋间神经阻滞对儿童先天性心脏病手术患者术后早期功能恢复的影响

摘要

背景：心脏手术后，患者通常会经历严重的急性疼痛，直接影响术后早期功能恢复，导致住院时间延长以及医疗费用增加。此外，急性疼痛若未得到及时有效的控制，可能进一步发展为慢性术后疼痛，对患者的长期生活质量产生负面影响。因此，优化围术期疼痛管理对于促进患者术后早期功能恢复具有重要意义。作为多模式镇痛的重要组成部分，周围神经阻滞技术已在基本外科、骨科、妇科、胸科等领域的围术期疼痛管理中得到广泛应用。近年来，其在心脏外科领域的应用也逐渐受到关注。然而，超声引导下肋间神经阻滞（Intercostal nerve block, ICNB）在儿童先天性心脏病（简称先心病）手术中的临床应用尚未被充分研究。为此，本研究旨在探讨超声引导下ICNB对儿童先心病手术患者术后早期功能恢复的影响。

方法：本研究为回顾性队列研究，纳入2023年8月1日至2024年7月31日期间在中国医学科学院阜外医院接受侧开胸房间隔缺损修补术和/或室间隔缺损修补术的儿童患者（≤6岁）。根据患者是否接受了超声引导下ICNB，将其分为ICNB组和对照组。采用重复测量的一般线性模型评估超声引导下ICNB对围术期阿片类药物用量及术后疼痛评分的影响。通过单因素和多因素Logistic回归分析评估超声引导下ICNB对术后谵妄的影响。此外，采用了倾向性评分匹配以减少混杂因素的影响，比较匹配后两组患者术后临床结局的差异。

结果：本研究共纳入266名儿童患者，ICNB组83名，对照组183名。重复测量的一般线性模型显示，ICNB显著减少了围术期每日阿片类药物用量（F = 566.3, P < 0.001），降低了术后每日疼痛评分（F = 49.1, P < 0.001）。Logistic回归分析显示，ICNB是术后谵妄的独立保护因素（OR: 0.150, 95%CI: 0.055-0.413, P < 0.001）。后续对两组患者进行倾向性评分匹配以减少混杂因素的影响，最终得到71对配对组。匹配队列结果显示，ICNB组的镇痛效果更佳，能够显著减少术中（1.0 vs. 2.2, mg/kg, P < 0.001）及术后（0.0 vs. 3.0, mg/kg, P < 0.001）阿片类药物用量，降低术后最高疼痛评分（1.0 vs. 3.0, P < 0.001），减少镇痛药物的补救需求（63.4% vs. 97.2%, P < 0.001），并延迟镇痛药物的首次补救时间（33.9 vs. 0.0, h, P < 0.001）。此外，ICNB不仅能够降低术后恶心呕吐（2.8% vs. 19.7%, P = 0.001）及肺不张（4.2% vs. 15.5%, P = 0.024）的发生率，还有助于优化其他临床结局，包括缩短首次饮水时间（9.8 vs. 16.1, h, P < 0.001）、首次进食时间（14.3 vs. 20.9, h, P < 0.001）及首次排便时间（48.1 vs. 71.7, h, P < 0.001），加快尿管（18.5 vs. 20.5, h, P = 0.014）和中心静脉导管（116.6 vs. 136.8, h, P = 0.032）的拔除时间，提高术后最低氧合指数（445.3 vs. 330.0, mmHg, P < 0.001），并且缩短机械通气时间（2.0 vs. 3.0, h, P = 0.001）和住院时间（7.3 vs 9.0, d, P = 0.004）。尽管两组患者关于术后谵妄率、再手术率、再入重症监护室率以及30天再入院率方面无统计学差异，但是ICNB组患者关于以上事件的发生率均低于对照组。

结论：超声引导下ICNB能够减少儿童简单先心病手术患者的围术期阿片类药物用量，降低术后疼痛评分，减少相关并发症的发生率，缩短机械通气时间和住院时间，从而促进患者术后早期功能恢复。

关键词：儿童，先天性心脏病，多模式镇痛，肋间神经阻滞

第二部分 加速康复外科策略对儿童复杂性先天性心脏病手术患者短期临床结局的影响

摘要

背景：加速康复外科（Enhance recovery after surgery, ERAS）策略基于循证医学证据，通过多学科协作优化围术期管理，旨在减少手术创伤和应激反应，加速患者术后早期康复。随着ERAS理念的不断发展，其应用范围已从结直肠外科逐步拓展至多个外科领域。然而，ERAS策略在儿童复杂性先天性心脏病（简称复杂先心病）手术中的可行性和有效性尚不明确。本研究基于ERAS指南和专家共识，结合临床实践经验，制定了针对儿童复杂先心病患者的ERAS管理方案。通过收集院内临床结果，旨在探讨ERAS策略对此类患者短期临床结局的影响。

方法：本研究为前瞻性队列研究，纳入2023年7月1日至2024年11月1日期间在中国医学科学院阜外医院接受复杂先心病手术治疗的儿童患者（≤6岁）。根据患者是否接受了ERAS策略，将其分为ERAS组和常规组。本研究将复合终点事件的发生率作为主要结局指标，包括主要心血管不良事件、肺部并发症、中重度急性肾损伤。采用1:1倾向性评分匹配以减少混杂因素的影响，并通过条件Logistic回归分析评估ERAS策略对二分类结局变量的影响，同时采用Hodges-Lehmann分析评估ERAS策略对连续性结局变量的影响。此外，为验证研究结论的稳健性，对不同亚组人群和整个研究队列实施了亚组分析和敏感性分析。

结果：本研究共纳入601名儿童患者，其中ERAS组271名，常规组330名。1:1倾向性评分匹配得到229对配对组。关于主要结局，匹配队列结果显示，ERAS策略显著降低了复合终点事件的发生率（8.7% vs. 21.0%, OR: 0.417, 95%CI: 0.247-0.702, P = 0.001）。亚组分析和敏感性分析的结果均与匹配队列的结论一致，进一步验证了研究结论的稳健性。关于次要结局，ERAS策略显著降低了多种围术期并发症的发生率，包括主要心血管不良事件（2.2% vs. 8.3%, OR: 0.263, 95%CI: 0.098-0.705, P = 0.008）、早期低心排综合征（2.2% vs. 7.9%, OR: 0.278, 95%CI: 0.103-0.748, P = 0.011）、肺部并发症（3.9% vs. 13.5%, OR: 0.290, 95%CI: 0.138-0.610, P = 0.001）、中重度肺不张（3.5% vs. 10.9%, OR: 0.320, 95%CI: 0.144-0.709, P = 0.005）、肺损伤（0.4% vs. 3.9%, OR: 0.111, 95%CI: 0.014-0.877, P = 0.037）、恶心呕吐（6.1% vs. 18.8%, OR: 0.326, 95%CI: 0.178-0.595, P < 0.001）、延迟拔管（4.4% vs. 11.4%, OR: 0.385, 95%CI: 0.185-0.798, P = 0.010）、肺炎（7.0% vs. 16.2%, OR: 0.432, 95%CI: 0.241-0.777, P = 0.005）、肺不张（13.5% vs. 27.1%, OR: 0.500, 95%CI: 0.325-0.770, P = 0.002）、再次气管插管（1.3% vs. 4.8%, OR: 0.273, 95%CI: 0.076-0.978, P = 0.046）、再次入ICU（3.9% vs. 9.6%, OR: 0.409, 95%CI: 0.188-0.888, P = 0.024）、术后谵妄（17.4% vs. 42.5%, OR: 0.409, 95%CI: 0.280-0.596, P < 0.001）以及术后躁动（6.4% vs. 20.5%, OR: 0.311, 95%CI: 0.171-0.567, P < 0.001）。此外，ERAS策略还显著减少了围术期阿片类使用总量（MD: 2.938, 95%CI: 2.643-3.237, P < 0.001），降低了术后最高疼痛评分（MD: 2.000, 95%CI: 2.000-3.000, P < 0.001），缩短了首次饮水时间（MD: 5.567, 95%CI: 3.900-7.433, P < 0.001）、首次进食时间（MD: 5.717, 95%CI: 3.617-7.933, P < 0.001）及首次排便时间（MD: 14.883, 95%CI: 3.750-22.717, P = 0.005），加快了尿管（MD: 1.400, 95%CI: 0.367-2.667, P = 0.040）、动脉导管（MD: 11.950, 95%CI: 3.417-20.450, P = 0.025）及中心静脉导管（MD: 18.750, 95%CI: 0.967-25.867, P = 0.040）的拔除时间，提高了术后最低氧合指数（MD: -65.143; 95%CI: -89.333, -40.667; P < 0.001），减少了最高血管活性药物评分（MD: 1.500, 95%CI: 0.001-2.000, P = 0.043），并且缩短了机械通气时间（MD: 3.000, 95%CI: 2.000-4.000, P < 0.001）和ICU住院时间（MD: 0.135, 95%CI: 0.001-0.868, P = 0.012），从而加速了患者术后早期康复。

结论：ERAS策略能够改善儿童复杂先心病手术患者的短期临床结局，降低围术期并发症的发生率，减少围术期阿片类药物用量及术后疼痛评分，并缩短机械通气时间和ICU住院时间，从而加速了患者术后早期康复。

关键词：儿童，先天性心脏病，加速康复外科，围术期管理，短期结局

第三部分 加速康复外科策略对儿童复杂性先天性心脏病手术患者中期临床结局的影响

摘要

背景：加速康复外科（Enhance recovery after surgery, ERAS）策略通过优化围术期管理，能够减少围术期并发症的发生率，改善临床预后，并加速患者术后早期康复。然而，目前大多数研究主要聚焦于ERAS策略对患者短期临床结局的影响，尚无研究探索ERAS策略对儿童复杂性先天性心脏病（简称复杂先心病）手术患者中期临床结局的影响。本研究通过收集患者的中期临床结果，旨在探讨ERAS策略对儿童复杂先心病手术患者中期临床结局的影响。

方法：本研究为前瞻性队列研究，纳入2023年7月1日至2024年11月1日期间在中国医学科学院阜外医院接受复杂先心病手术的儿童患者（≤6岁）。根据患者是否接受了ERAS策略，将其分为ERAS组和常规组。分别于术后30天和90天电话随访患者的中期临床结局。采用1:1倾向性评分匹配以减少混杂因素的影响，并通过COX等比例风险模型评估ERAS策略对中期临床结局（全因死亡、再次手术、再次入院）的影响。此外，为验证研究结论的稳健性，对整个研究队列实施了敏感性分析。

结果：本研究共纳入588名儿童患者，其中ERAS组268名，常规组320名。1:1倾向性评分匹配得到227对配对组。在术后90天的随访期间，匹配队列的ERAS组无患者死亡，而常规组有3例患者死亡，其中2例为院内死亡，院内死亡率为 0.9%（2/227）。匹配队列结果显示，ERAS策略显著降低了术后90天再入院率(7.0% vs. 15.0%, HR: 0.446, 95%CI: 0.224-0.813, P = 0.008)，其中，ERAS策略主要降低了术后90天非心血管原因再入院率（5.3% vs. 11.9%, HR: 0.418, 95%CI: 0.210-0.832, P = 0.013）。尽管ERAS策略与术后30天死亡率、30天再手术率、30天再入院率、90天死亡率以及90天再手术率之间无显著相关性，但ERAS组患者关于以上事件的发生率均低于常规组。敏感性分析的结果与匹配队列的结论一致，进一步验证了研究结论的稳健性。ERAS策略还显著提高了满意度评分（50 vs. 45, P < 0.001），有助于优化患者及家属的整体就医体验。此外，ERAS组患者的术后90天体重增加值为1.0（0.5, 2.0）kg，而常规组为1.0（0.4, 1.5）kg，ERAS组患者的术后90天体重增加值高于常规组（P = 0.043），这可能与ERAS组患者术后90天需要控制饮食量的比例相较于常规组更低有关（28.2% vs. 46.7%, P < 0.001）。

结论：ERAS策略能够改善儿童复杂先心病手术患者的中期临床结局，降低再入院率，促进患者术后体重恢复，并提高患者及家属的满意度评分，从而全面优化其整体就医体验。

Section 1: The impact of ultrasound-guided intercostal nerve block on early postoperative functional recovery in pediatric patients undergoing congenital heart disease surgery

Abstract

Background: After cardiac surgery, patients often experience severe acute pain, which directly impacts early postoperative functional recovery, leading to prolonged hospital stays and increased medical costs. Moreover, if acute pain is not promptly and effectively controlled, it may progress to chronic postoperative pain, negatively impacting the patient's long-term quality of life. Therefore, optimizing perioperative pain management is important for enhancing early postoperative functional recovery. As an important component of multimodal analgesia, the peripheral nerve block technique has been widely utilized in perioperative pain management across various surgical specialties, including general surgery, orthopedics, gynecology, and thoracic surgery. In recent years, its application in cardiac surgery has also garnered increasing attention. However, the clinical application of ultrasound-guided intercostal nerve block (ICNB) in pediatric congenital heart disease surgery has not been fully explored. Thereby, this study aims to investigate the impact of ultrasound-guided ICNB on early postoperative functional recovery in pediatric patients undergoing congenital heart disease surgery.

Methods: This study is a retrospective cohort study that included pediatric patients (≤6 years) who underwent lateral thoracotomy for atrial septal defect repair and/or ventricular septal defect repair at Fuwai Hospital, Chinese Academy of Medical Sciences, between August 1, 2023, and July 31, 2024. Patients were categorized into ICNB and control groups based on whether they received ultrasound-guided ICNB. Repeated measures of general linear models were used to evaluate the impact of ultrasound-guided ICNB on perioperative opioid consumption and postoperative pain scores. Univariate and multivariate Logistic regression analyses were performed to assess the impact of ultrasound-guided ICNB on postoperative delirium. In addition, propensity score matching was employed to reduce the influence of confounding factors, allowing for comparing the differences in postoperative clinical outcomes between the matched groups.

Results: A total of 266 pediatric patients were included in this study, with 83 in the ICNB group and 183 in the control group. Repeated measures of general linear models revealed that ICNB significantly decreased perioperative daily opioid consumption (F = 566.3, P < 0.001) and postoperative daily pain scores (F = 49.1, P < 0.001). Logistic regression analysis identified ICNB as an independent protective factor against postoperative delirium (OR: 0.150, 95%CI: 0.055-0.413, P < 0.001). Subsequently, propensity score matching was performed on the two groups of patients to mitigate the influence of confounding factors, ultimately yielding 71 matched pairs. The matched cohort results showed that the ICNB group had superior analgesic effects, significantly reducing intraoperative (1.0 vs. 2.2, mg/kg, P < 0.001) and postoperative (0.0 vs. 3.0, mg/kg, P < 0.001) opioid consumption, lowering the highest postoperative pain scores (1.0 vs. 3.0, P < 0.001), decreasing the need for rescue analgesia (63.4% vs. 97.2%, P < 0.001), and delaying the time first to rescue analgesia (33.9 vs. 0.0, h, P < 0.001). In addition, ICNB not only reduced the incidence of postoperative nausea and vomiting (2.8% vs. 19.7%, P = 0.001) and atelectasis (4.2% vs. 15.5%, P = 0.024), but also helped optimize other clinical outcomes. These included shortening the time to first drinking (9.8 vs. 16.1, h, P < 0.001), first feeding (14.3 vs. 20.9, h, P < 0.001), and first defecation (48.1 vs. 71.7, h, P < 0.001), accelerating the removal times of urinary catheters (18.5 vs. 20.5, h, P = 0.014) and central venous catheters (116.6 vs. 136.8, h, P = 0.032), improving the postoperative lowest oxygenation index (445.3 vs. 330.0, mmHg, P < 0.001), and reducing the duration of mechanical ventilation (2.0 vs. 3.0, h, P = 0.001) and length of hospital stay (7.3 vs 9.0, d, P = 0.004). Although there were no statistically significant differences between the two groups in terms of postoperative delirium rate, reoperation rate, readmission to the intensive care unit rate, and 30-day readmission rate, the incidences of these events in the ICNB group were consistently lower than that in the control group.

Conclusions: Ultrasound-guided ICNB can reduce perioperative opioid consumption, lower postoperative pain scores, decrease the incidence of related complications, and shorten both mechanical ventilation time and hospital stay in pediatric patients undergoing simple congenital heart disease surgery, thereby promoting early postoperative functional recovery.

Keywords: Children, Congenital heart disease, Multimodal analgesia, Intercostal nerve block

Section 2: The impact of enhanced recovery after surgery strategy on short-term clinical outcomes in pediatric patients undergoing complex congenital heart disease surgery

Abstract

Background: The enhanced recovery after surgery (ERAS) strategy, rooted in evidence-based medicine, aims to optimize perioperative management through multidisciplinary collaboration, with the goal of reducing surgical trauma and stress responses, thereby accelerating patient postoperative recovery. With the continuous evolution of the ERAS concept, its application has extended from colorectal surgery to multiple surgical fields. However, the feasibility and efficacy of the ERAS strategy in pediatric patients undergoing complex congenital heart disease surgery remain unclear. Based on ERAS guidelines and expert consensus, combined with clinical practice experience, this study developed an ERAS protocol tailored to pediatric patients with complex congenital heart disease. By collecting in-hospital clinical outcomes, the study aims to investigate the impact of the ERAS strategy on short-term clinical outcomes in this patient population.

Methods: This study is a prospective observational study that includes pediatric patients (≤6 years) who underwent surgery for complex congenital heart disease at Fuwai Hospital, Chinese Academy of Medical Sciences, between July 1, 2023, and November 1, 2024. Patients were categorized into the ERAS and the conventional groups based on whether they received the ERAS strategy. The primary outcome was the incidence of composite endpoint events, including major adverse cardiovascular events, pulmonary complications, and moderate-to-severe acute kidney injury. Propensity score matching with a 1:1 ratio was conducted to minimize the influence of confounding factors. The impact of the ERAS strategy on binary outcome variables was assessed using conditional Logistic regression analysis, while the Hodges-Lehmann estimator analysis was used to evaluate its impact on continuous outcome variables. Additionally, subgroup analysis and sensitivity analysis were conducted in both the subgroup cohort and the overall cohort to verify the robustness of the conclusions.

Results: 601 pediatric patients were enrolled, including 271 in the ERAS group and 330 in the conventional group. Propensity score matching with a 1:1 ratio yielded 229 matched pairs. Regarding the primary outcome, the matched cohort results demonstrated that the ERAS strategy significantly reduced the incidence of composite endpoint events (8.7% vs. 21.0%, OR: 0.417, 95%CI: 0.247-0.702, P = 0.001). The results of subgroup analysis and sensitivity analysis were consistent with the matched cohort findings, further validating the robustness of the conclusions. Regarding secondary outcomes, the ERAS strategy significantly reduced the incidence of multiple perioperative complications, including major adverse cardiovascular events (2.2% vs. 8.3%, OR: 0.263, 95%CI: 0.098-0.705, P = 0.008), early low cardiac output syndrome (2.2% vs. 7.9%,OR: 0.278, 95%CI: 0.103-0.748, P = 0.011), pulmonary complications (3.9% vs. 13.5%, OR: 0.290, 95%CI: 0.138-0.610, P = 0.001), moderate to severe atelectasis (3.5% vs. 10.9%, OR: 0.320, 95%CI: 0.144-0.709, P = 0.005), pulmonary injury (0.4% vs. 3.9%, OR: 0.111, 95%CI: 0.014-0.877, P = 0.037), nausea and vomiting (6.1% vs. 18.8%, OR: 0.326, 95%CI: 0.178-0.595, P < 0.001), delayed extubation (4.4% vs. 11.4%, OR: 0.385, 95%CI: 0.185-0.798, P = 0.010), pulmonary pneumonia (7.0% vs. 16.2%, OR: 0.432, 95%CI: 0.241-0.777, P = 0.005), atelectasis (13.5% vs. 27.1%, OR: 0.500, 95%CI: 0.325-0.770, P = 0.002), reintubation (1.3% vs. 4.8%, OR: 0.273, 95%CI: 0.076-0.978, P = 0.046), ICU readmission (3.9% vs. 9.6%, OR: 0.409, 95%CI: 0.188-0.888, P = 0.024), postoperative delirium (17.4% vs. 42.5%, OR: 0.409, 95%CI: 0.280-0.596, P < 0.001), and postoperative agitation (6.4% vs. 20.5%, OR: 0.311,OR: 0.311, 95%CI: 0.171-0.567, P < 0.001). Additionally, the ERAS strategy significantly decreased the total perioperative opioid consumption (MD: 2.938, 95%CI: 2.643-3.237, P < 0.001), reduced the highest postoperative pain scores (MD: 2.000, 95%CI: 2.000-3.000, P < 0.001), shortened the time to first drinking (MD: 5.567, 95%CI: 3.900-7.433, P < 0.001), first feeding (MD: 5.717, 95%CI: 3.617-7.933, P < 0.001), and first defecation (MD: 14.883, 95%CI: 3.750-22.717, P = 0.005), accelerated the removal times of urinary catheters (MD: 1.400, 95%CI: 0.367-2.667, P = 0.040), arterial catheters (MD: 11.950, 95%CI: 3.417-20.450, P = 0.025), and central venous catheters (MD: 18.750, 95%CI: 0.967-25.867, P = 0.040), improved the postoperative minimum oxygenation index (MD: -65.143; 95%CI: -89.333, -40.667; P < 0.001), reduced the maximum vasoactive inotropic score (MD: 1.500, 95%CI: 0.001-2.000, P = 0.043), and shortened the durations of mechanical ventilation (MD: 3.000, 95%CI: 2.000-4.000, P < 0.001) and intensive care unit stay (MD: 0.135, 95%CI: 0.001-0.868, P = 0.012), thereby accelerating the early postoperative recovery process for patients.

Conclusions: The ERAS strategy can improve the short-term clinical outcomes of pediatric patients undergoing complex congenital heart disease surgery, reduce the incidence of perioperative complications, decrease perioperative opioid consumption and postoperative pain scores, and shorten both mechanical ventilation time and ICU stay, thereby accelerating the early postoperative recovery process for patients.

Keywords: Children, Congenital heart disease, Enhanced recovery after surgery, Perioperative management, Short-term outcomes

Section 3: The impact of enhanced recovery after surgery strategy on mid-term clinical outcomes in pediatric patients undergoing complex congenital heart disease surgery

Abstract

Background: The enhanced recovery after surgery (ERAS) strategy, through optimizing perioperative management, can reduce the incidence of perioperative complications, improve clinical outcomes, and accelerate early postoperative recovery in patients. However, most current studies primarily focus on the impact of the ERAS strategy on short-term clinical outcomes, with limited research exploring its effects on mid-term clinical outcomes in pediatric patients undergoing complex congenital heart surgery. This study aims to investigate the impact of the ERAS strategy on mid-term clinical outcomes in pediatric patients with complex congenital heart disease by collecting mid-term clinical outcomes. 

Methods: This study is a prospective observational study that includes pediatric patients (≤6 years) who underwent surgery for complex congenital heart disease at Fuwai Hospital, Chinese Academy of Medical Sciences, between July 1, 2023, and November 1, 2024. Patients were categorized into the ERAS and the conventional groups based on whether they received the ERAS strategy. Follow-up assessments were conducted via telephone at 30 and 90 days postoperatively to evaluate mid-term clinical outcomes. Propensity score matching with a 1:1 ratio was conducted to reduce the influence of confounding factors. The impact of the ERAS strategy on mid-term clinical outcomes (all-cause mortality, reoperation, and readmission) was assessed by Cox proportional hazards models. In addition, sensitivity analysis was performed on the entire cohort to verify the robustness of the conclusions.

Results: 588 pediatric patients were enrolled, including 268 in the ERAS group and 320 in the conventional group. Propensity score matching with a 1:1 ratio yielded 227 matched pairs. Within 90 days postoperatively, no deaths occurred in the ERAS group, whereas three deaths were recorded in the conventional group, including two in-hospital deaths, resulting in an in-hospital mortality rate of 0.9% (2/227). The matched cohort results demonstrated that the ERAS strategy significantly reduced the 90-day readmission rate (7.0% vs. 15.0%, HR: 0.446, 95%CI: 0.224-0.813, P = 0.008), primarily reducing non-cardiovascular-related readmission rate within 90 days postoperatively (5.3% vs. 11.9%, HR: 0.418, 95%CI: 0.210-0.832, P = 0.013). Although no significant associations were observed between the ERAS strategy and 30-day mortality, 30-day reoperation rate, 30-day readmission rate, 90-day mortality, or 90-day reoperation rate, the incidences of these events were consistently lower in the ERAS group compared to the conventional group. The sensitivity analysis results were consistent with the matched cohort findings, further validating the robustness of the conclusions. The ERAS strategy significantly improved satisfaction scores (50 vs. 45, P < 0.001), enhancing the overall healthcare experience for patients and their families. Additionally, the weight gain at 90 days postoperatively was 1.0 (0.5, 2.0) kg in the ERAS group, compared to 1.0 (0.4, 1.5) kg in the conventional group. The weight gain in the ERAS group was significantly higher than that in the conventional group (P = 0.043), which might be associated with the lower proportion of patients in the ERAS group who needed to control their dietary intake at 90 days postoperatively compared to the conventional group (28.2% vs. 46.7%, P < 0.001).

Conclusion: The ERAS strategy can improve mid-term clinical outcomes in pediatric patients undergoing surgery for complex congenital heart disease, reduce readmission rates, promote postoperative weight recovery, and enhance satisfaction scores among patients and their families, thereby comprehensively optimizing the overall healthcare experience.