Introduction:Enhanced recovery after surgery (ERAS) protocols reduce morbidity, hospital costs, and length of hospital stay although there have been few studies in living donor nephrectomy patients, and no prior published protocols avoid non-steroidal anti-inflammatory drugs (NSAIDs).

Methods: We performed a single-center retrospective analysis of living donor nephrectomy patients pre- and post-ERAS protocol implementation. All living donor nephrectomy patients were included post-implementation. Our protocol utilizes transversus abdominal pain blocks and minimizes perioperative narcotics while using intraoperative ketamine and perioperative lidocaine as well as scheduled acetaminophen and gabapentin without NSAID use. Patient American Society of Anesthesiologists (ASA) classification, gender, and body-mass index (BMI), intraoperative and inpatient morphine equivalents, and outpatient narcotic prescription data were obtained. Length of stay was abstracted from hospital billing records.

Results: We included 176 patients in this analysis; 113 were pre-implementation of the protocol (2/07/2013 – 7/27/2015) and 62 were post-implementation (7/28/2015 – 10/4/2016). There was no difference in ASA classification, gender, BMI, or preoperative morphine equivalent use between the two groups. All procedures were performed laparoscopically. Intraoperative and Post Anesthesia Care Unit morphine equivalents were significantly reduced between pre- and post-implementation of protocol (39.21 vs 4.38, p <0.001 and 7.24 vs 2.54, p < 0.001 respectively). Mean and median length of stay decreased between pre- and post-implementation phases (2.85 vs. 2.48 and 2.43 vs 2.35, p<0.001, respectively). Readmission events within 30 days were not statistically different between groups. Postoperative, outpatient narcotic refill needs were unchanged between the groups over the first 30 days (23.89% vs. 20.96%, p=0.699).

Conclusion: A living donor nephrectomy ERAS protocol has shortened length of stay, estimating approximately 40 hospital bed-days can be liberated annually with this approach. There has also been a significant decrease in perioperative opiate use without the utilization of NSAIDs or increased adverse outcomes such as readmissions or outpatient narcotic utilization needs.

CITATION INFORMATION: Forbes R, King A, McGrane T, Hale D, Sandberg W, Wanderer J, McEvoy M. Enhanced Recovery After Surgery Pathway for Living Donor Nephrectomy Patients Decreases Length of Stay and Narcotic Utilization. Am J Transplant. 2017;17 (suppl 3).

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