Enhanced Recovery After Living Donor Nephrectomy: Reduced Opioid Use and Shorter Hospitalization in a Contemporary...

Area of Science:

• Nephrology
• Surgical Outcomes
• Transplantation Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care pathways designed to optimize patient recovery.
• Living donor nephrectomy (LDN) involves the surgical removal of a kidney from a living donor for transplantation.
• Implementing ERAS in LDN aims to reduce physiological stress and improve post-operative outcomes.

Purpose of the Study:

• To evaluate the impact of ERAS protocols on post-surgical outcomes in living donor nephrectomy (LDN).
• To assess the safety and effectiveness of ERAS implementation in LDN patients.
• To compare key recovery metrics between ERAS and traditional care pathways in LDN.

Main Methods:

• A retrospective single-center cohort study analyzed LDN patients from January 1, 2024, to December 31, 2024.
• Outcomes were compared between patients managed with ERAS protocols and those who received standard pre-ERAS care.
• Key metrics included post-donation length of stay, complication rates, and opioid utilization.

Main Results:

• The ERAS group (61 patients) demonstrated significantly lower post-operative patient-controlled analgesia (PCA) use (10% vs. 88%, P < .001).
• ERAS patients experienced a shorter median length of stay (1 day vs. 2 days, P < .001) and reduced discharge opioid MME (12 vs. 112.5, P < .001).
• The ERAS group showed a trend towards fewer overall complications (21.3% vs. 30.2%, P = .36) and significantly fewer GI-related complications (8.1% vs. 26.4%, P = .03).

Conclusions:

• ERAS protocols significantly enhance post-surgical recovery in living donor nephrectomy.
• Implementation of ERAS leads to reduced hospital length of stay and decreased opioid consumption.
• ERAS protocols are associated with fewer gastrointestinal complications, supporting their adoption in LDN care pathways.