scholarly journals Introduction of an enhanced recovery protocol into a laparoscopic living donor nephrectomy programme

2020 ◽  
Vol 102 (3) ◽  
pp. 204-208 ◽  
Author(s):  
T Brown ◽  
F Magill ◽  
N Beckett ◽  
S Kanabar ◽  
J Monserez ◽  
...  
Keyword(s):  
Living Donor ◽  
Enhanced Recovery ◽  
Postoperative Recovery ◽  
Donor Nephrectomy ◽  
Fluid Restriction ◽  
Potential Donor ◽  
Living Donor Nephrectomy ◽  
Pain Scores ◽  
Enhanced Recovery Protocol ◽  
The Impact

Introduction Living-donor renal transplantation is the optimal treatment for patients with end-stage renal disease. The rate of living donation in the UK is sub-optimal, and potential donor concerns regarding postoperative recovery may be contributory. Enhanced recovery programmes are well described for a number of surgical procedures, but experience in living-donor surgery is sparse. This study reports the impact of introducing an enhanced recovery protocol into a living-donor renal transplant programme. Materials and methods All consecutive patients undergoing laparoscopic living-donor nephrectomy over a 25-month period were included. The principles of enhanced recovery were fluid restriction, morphine sparing and expectation management. Outcome measures were postoperative pain scores and complications for donor and recipients. Results Standard care was provided for 24 (30%) patients and 57 (70%) followed an enhanced recovery pathway. The latter group received significantly less preoperative intravenous fluid (0ml vs 841ml p < 000.1) and opiate medication (14.83mg vs 23.85mg p = 0.001). Pain scores, postoperative complications and recipient transplant outcomes were comparable in both groups. Conclusions Enhanced recovery for living-donor nephrectomy is a safe approach for donors and recipients. Application of these techniques and further refinement should be pursued to enhance the experience of living donors.

scholarly journals Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

2019 ◽  
Vol 34 (11) ◽  
pp. 4901-4908 ◽  
Author(s):  
Kosei Takagi ◽  
Hendrikus J. A. N. Kimenai ◽  
Jan N. M. IJzermans ◽  
Robert C. Minnee
Keyword(s):  
Body Mass Index ◽  
Kidney Function ◽  
Body Mass ◽  
Living Donor ◽  
Postoperative Outcome ◽  
Donor Nephrectomy ◽  
Postoperative Outcomes ◽  
Laparoscopic Donor Nephrectomy ◽  
Living Donor Nephrectomy ◽  
The Impact

Abstract Background The aim of this study was to examine the difference in outcome between hand-assisted retroperitoneoscopic and laparoscopic living donor nephrectomy in obese donors, and the impact of donor body mass index on outcome. Methods Out of 1108 living donors who underwent hand-assisted retroperitoneoscopic or laparoscopic donor nephrectomy between 2010 and 2018, 205 were identified having body mass index ≥ 30. These donors were included in this retrospective study, analyzing postoperative outcomes and remnant renal function. Results Out of 205 donors, 137 (66.8%) underwent hand-assisted retroperitoneoscopic donor nephrectomy and 68 donors (33.2%) underwent laparoscopic donor nephrectomy. Postoperative outcome did not show any significant differences between the hand-assisted retroperitoneoscopic donor nephrectomy group and the laparoscopic donor nephrectomy group in terms of major complications (2.2% vs. 1.5%, P = 0.72), postoperative pain scale (4 vs. 4, P = 0.67), and the length of stay (3 days vs. 3 days, P = 0.075). The results of kidney function in donors after nephrectomy demonstrated no significant differences between the groups. Additional analysis of 29 donors with body mass index ≥ 35 (14.1%) as compared with 176 donors with body mass index 30–35 (85.9%) revealed no significant differences between groups in postoperative outcomes as well as kidney function after donation. Conclusion Our results show that laparoscopic living donor nephrectomy for obese donors is safe and feasible with good postoperative outcomes. There were no significant differences regarding postoperative outcome between hand-assisted retroperitoneoscopic and laparoscopic donor nephrectomy. Furthermore, the outcome in donors with body mass index ≥ 35 was comparable to donors with body mass index 30–35.

scholarly journals Feasibility, Safety and Efficacy of Enhanced Recovery after Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 10 (1) ◽  
pp. 21
Author(s):  
Apostolos Prionas ◽  
Charles Craddock ◽  
Vassilios Papalois
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Living Donor ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Donor Nephrectomy ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Living Donor Nephrectomy

This meta-analysis aims to compare enhanced recovery after surgery (ERAS) vs. standard perioperative practice in the management of living kidney donors. Primary endpoints included mortality, complications, length of stay (LOS) and quality of life after living donor nephrectomy. Medline, Embase, Scopus, Cochrane and Web of Science databases were searched. In total, 3029 records were identified. We then screened 114 full texts. Finally, 11 studies were included in the systematic review corresponding to 813 living donors. Of these, four randomized controlled trials were included in the meta-analysis. ERAS resulted in shorter LOS (95CI: −1.144, −0.078, I2 = 87.622%) and lower incidence of post-operative complications (95CI: 0.158, 0.582, I2 = 0%). This referred to Clavien–Dindo I-II complications (95CI: 0.158, 0.582, I2 = 0%). There was no difference in Clavien–Dindo III-V complications (95CI: 0.061,16.173, I2 = 0%). ERAS donors consumed decreased amounts of narcotics during their hospital stay (95CI: −27.694, −8.605, I2 = 0%). They had less bodily pain (95CI: 6.735, 17.07, I2 = 0%) and improved emotional status (95CI: 6.593,13.319, I2 = 75.682%) one month postoperatively. ERAS protocols incorporating multimodal pain control interventions resulted in a mean reduction of 1 day in donors’ LOS (95CI: −1.374, −0.763, I2 = 0%). Our results suggest that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy.

scholarly journals Implementation of an Enhanced Recovery After Spine Surgery program at a large cancer center: a preliminary analysis

2018 ◽  
Vol 29 (5) ◽  
pp. 588-598 ◽  
Author(s):  
Roxana M. Grasu ◽  
Juan P. Cata ◽  
Anh Q. Dang ◽  
Claudio E. Tatsui ◽  
Laurence D. Rhines ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Enhanced Recovery ◽  
Recovery Process ◽  
Postoperative Recovery ◽  
Opioid Consumption ◽  
Pelvic Surgery ◽  
Cancer Center ◽  
Team Approach ◽  
Pain Scores ◽  
The Impact

OBJECTIVEEnhanced Recovery After Surgery (ERAS) programs follow a multimodal, multidisciplinary perioperative care approach that combines evidence-based perioperative strategies to accelerate the functional recovery process and improve surgical outcomes. Despite increasing evidence that supports the use of ERAS programs in gastrointestinal and pelvic surgery, data regarding the development of ERAS programs in spine surgery are scarce. To evaluate the impact of an Enhanced Recovery After Spine Surgery (ERSS) program in a US academic cancer center, the authors introduced such a program and hypothesized that ERSS would have a significant influence on meaningful clinical measures of postoperative recovery, such as pain management, postoperative length of stay (LOS), and complications.METHODSA multimodal, multidisciplinary, continuously evolving team approach was used to develop an ERAS program for all patients undergoing spine surgery for metastatic tumors at The University of Texas MD Anderson Cancer Center from April 2015 through September 2016. This study describes the introduction of that ERSS program and compares 41 patients who participated in ERSS with a retrospective cohort of 56 patients who underwent surgery before implementation of the program. The primary objectives were to assess the effect of an ERSS program on immediate postoperative pain scores and in-hospital opioid consumption. The secondary objectives included assessing the effect of ERSS on postoperative in-hospital LOS, 30-day readmission rates, and 30-day postoperative complications.RESULTSThe ERSS group showed a trend toward better pain scores and decreased opioid consumption compared with the pre-ERSS group. There were no significant differences in LOS, 30-day readmission rate, or 30-day complication rate observed between the two groups.RESULTSAn ERSS program is feasible and potentially effective on perioperative pain control and opioid consumption, and can expedite recovery in oncological spine surgery patients. Larger-scale research on well-defined postoperative recovery outcomes is needed.

scholarly journals SP5.2.2 A Systematic Review of Living Kidney Donor Enhanced Recovery After Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Matthew Byrne ◽  
Ahmed Mehmood ◽  
Dominic Summers ◽  
Sarah Hosgood ◽  
Michael Nicholson
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Living Donor ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Donor Nephrectomy ◽  
Live Donor ◽  
Live Donor Nephrectomy ◽  
Living Donor Nephrectomy ◽  
Significant Difference

Abstract Background Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stays without increasing readmission or mortality. However, its role in living donor nephrectomy has not yet been defined. This systematic review aimed to describe the literature on ERAS in live donor nephrectomy. Methods Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 1/7/19 for all original randomised control and cohort studies relating to ERAS in living donor nephrectomy. The study was registered on PROSPERO (CRD: CRD42019141706). Results 1248 patients were identified from 14 studies (630 patients with ERAS and 618 patients without). There were considerable differences in the protocols used and compliance with general ERAS recommendations was poor. Meta-analysis revealed that with ERAS length of stay significantly reduced by 0.83 days (95% CI = 0.30-1.37, p = 0.002), there was a trend towards decreased readmission (OR = 0.45, 95% CI = 0.19=1.10, p = 0.08), and there was no significant difference in complications (OR = 0.73, 95% CI 0.16-3.39, p=0.69). Opiate usage was significantly reduced with ERAS in all studies that measured it and there was no significant difference in creatine clearance. Conclusions ERAS in live donor nephrectomy significantly reduces length of stay, and reduces opiate usage, without increasing readmission, complications, or creatinine. There is considerable variation in ERAS protocols used and a guideline for ERAS in live donor nephrectomy should be developed.

Sign in / Sign up

Export Citation Format

Share Document