Raval MV, Tian Y, Schäfer W, Balbale SN, Perez MN, Ingram MCE et al.
JAMA Surg 2026; 161: 670-680.
Some 597 children were included in a stepped-wedge trial of a 21-element enhanced recovery protocol; patient-level adherence rose from a median of 11 to 14 elements across study phases (P<0.001), but length of stay did not differ significantly by phase. Patients who received at least 13 protocol elements had a shorter length of stay (−1.14 days, 95 per cent confidence interval −2.01 to −0.27) and fewer complications (odds ratio 0.48, 0.28 to 0.82) than those with lower adherence.
Comment: Benefit depended on protocol fidelity.
Comment by Jeongyoon (Jenny) Moon, MD
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