Enhanced recovery after living donor nephrectomy. a prospective trial in a tertiary care center

You have accessJournal of UrologyCME1 Apr 2023MP31-20 ENHANCED RECOVERY AFTER LIVING DONOR NEPHRECTOMY. A PROSPECTIVE TRIAL IN A TERTIARY CARE CENTER Cristian Axel Hernández-Gaytán, Jorge Augusto Alcacio-Mendoza, Jose De Jesús Cendejas-Gómez, Javier González-Chavira, Humberto Zavaleta-Guraieb, Cassandra Dominguez-Hernández, Diana García-Campos, Rafael Paulino Leal-Villalpando, and Francisco Rodríguez-Covarrubias Cristian Axel Hernández-GaytánCristian Axel Hernández-Gaytán More articles by this author , Jorge Augusto Alcacio-MendozaJorge Augusto Alcacio-Mendoza More articles by this author , Jose De Jesús Cendejas-GómezJose De Jesús Cendejas-Gómez More articles by this author , Javier González-ChaviraJavier González-Chavira More articles by this author , Humberto Zavaleta-GuraiebHumberto Zavaleta-Guraieb More articles by this author , Cassandra Dominguez-HernándezCassandra Dominguez-Hernández More articles by this author , Diana García-CamposDiana García-Campos More articles by this author , Rafael Paulino Leal-VillalpandoRafael Paulino Leal-Villalpando More articles by this author , and Francisco Rodríguez-CovarrubiasFrancisco Rodríguez-Covarrubias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e438 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cristian Axel Hernández-Gaytán More articles by this author Jorge Augusto Alcacio-Mendoza More articles by this author Jose De Jesús Cendejas-Gómez More articles by this author Javier González-Chavira More articles by this author Humberto Zavaleta-Guraieb More articles by this author Cassandra Dominguez-Hernández More articles by this author Diana García-Campos More articles by this author Rafael Paulino Leal-Villalpando More articles by this author Francisco Rodríguez-Covarrubias More articles by this author Expand All Advertisement PDF downloadLoading ...