Urology resident National Institute of Medical Sciences and Nutrition Salvador Zubiran
Introduction: Enhanced recovery after surgery (ERAS) protocols are well established strategies involving multidisciplinary care of patients resulting in improved outcomes, reducing length of stay (LOS), postoperative pain and expedite return to regular activities. Although initially developed for colorectal surgery, ERAS has been tailored for different surgeries, including living donor nephrectomy (LDN). The objective of this study is to compare perioperative outcomes of ERAS vs. the standard of care (SOC) for LDN patients. Methods: Experimental, prospective, and comparative analysis of patients undergoing laparoscopic LDN (LLDN) in a tertiary care center in Mexico City. ERAS protocol comprised limited opioids and fluids, early oral intake, antiemetic prophylaxis, and multimodal analgesic consisting in ipsilateral transversus abdominis plane (TAP) and quadratus lumborum (QL) blockade, and paracetamol and metamizole. Postoperative pain was evaluated according to visual analogue scale (VAS). Primary endpoint was LOS. Secondary endpoints were surgical complication rate according to Clavien-Dindo score, re-admission rate, estimated blood-loss (EBL), use of intraoperative fluids, and postoperative pain. Trial was approved by interim ethics committee. Results: We compared 27 patients undergoing LLDN under ERAS protocol vs. 174 historical controls undergoing LLDN under SOC management. There were no differences in demographic variables. Major findings are reported in table 1. ERAS patients had lower LOS (1.44 vs 3.38 days). In terms of postoperative pain, there was no statistically significant difference between both groups. Regarding decline in eGFR ( < 59 ml/min/1.73m2) after LDN, ERAS group had only one patient (3.7%) vs 39 (22.4%) in SOC group. No major complications were reported. Conclusions: Our results show that ERAS protocol for LLDN patients is feasible and safe; it should be implemented as the new standard of care for kidney donors. SOURCE OF Funding: None
