Purpose. The study analyzes the impact of psychiatric history on postoperative length of hospital stay (LOS) of living kidney donors (LD) and initial assessment of introduction of enhanced recovery after surgery protocol (ERAS) on LOS.

Methods. We studied the LOS of LD undergoing traditional peri-operative (op) pain management (pre-ERAS group) and preliminary assessment of ERAS implementation (ERAS group) on LOS. LD underwent standard medical, surgical, psychological and social assessment. ERAS goal was to reduce opioid use in all care phases. Protocol included the following: 1.pre-op: acetaminophen, pregabalin, psychologist recommendations for pain coping skills, block of quadratus lumborum, 2. post induction: ketamine, dexamethasone, 3. post-op pain management: hydromorphone, acetaminophen, gabapentin, tramadol, supervised ambulation. Discharge criteria for all groups were: transition to oral pain medications, ambulating, deep breathing, urinating, return of bowel function. T- test was used for statistical analysis, p values are two tailed (Prism).

Results. Pre-ERAS group (n=86) consisted of 41 (47%) females, with African Americans (AA) (n=16, 18.4%), and Caucasians (C) (n=61, 71.2%). Mean age was 44 and was similar for ERAS & pre-ERAS groups, range 22-70 and 21-66 respectively. ERAS (n=11) group consisted of 7 (63%) females, 2 (18%) AA and 9 (81%) C. Surgeries were laparoscopic. None of the LD required; splenectomy, return to OR, or had surgical complications. 9 of 86 (10.5%) pre-ERAS group LD required Emergency Department (ED) treatment for pain within 2 weeks after discharge; compared to none in ERAS group. LOS: ERAS group donors stayed 1 day less. Pre-ERAS group mean LOS was 4.4 (SE= 0.15, range 3-9 days) versus ERAS group LOS of 3.5 (SE=0.1, range 3-4) (p<0.0001). There was no difference in LOS between female and male LD. LD with psychiatric history (depression, anxiety, ADHD, etc., n=25) had similar LOS as donors without such history (mean 4.41±0.12, range 3-7 vs. 4.44±0.2 days, range 3-9, ns).

Conclusion. LD with preexisting psychiatric disorders are not at risk of prolonged LOS. Preliminary results indicate successful shortening of LOS after implementation of ERAS. Whereas the difference is significant, in practice, we reduced LOS by 1 day. LOS in ERAS group seems to be more consistent. Further reduction of LOS may require additional measures.

CITATION INFORMATION: Loiselle M., Bruschwein H., Jacobs J., Gulin S., Rose T., Arora H., Nash R., Toledo A., Kozlowski T. Shortening Length of Post-Operative In-Patient Stay for Living Kidney Donors Am J Transplant. 2017;17 (suppl 3).

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