Implementation of a Comprehensive Protocol for Enhanced Recovery After Surgery (ERAS) in Kidney Transplant Recipients Improves Patient and Graft Outcomes
Mohamed Eltemamy, Paul J. Oh, Hafiz Umair Siddiqui, Yi-Chia Lin, M. Cecilia Lansang, Emilio Poggio, David Goldfarb, Venkatesh Krishnamurthi, Alvin Wee
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Abstract
Background
Enhanced recovery after surgery (ERAS) protocols have gained widespread acceptance as a means to enhance surgical outcomes. However, the intricate care required for kidney transplant recipients has not yet led to the establishment of a universally recognized and dependable ERAS protocol for kidney transplantation.
Objective
We devised a customized ERAS protocol to determine its effectiveness in improving surgical and postoperative outcomes among kidney transplant recipients.
Design, Setting, and Participants
This was a retrospective, single-center study performed at our tertiary care institution. Three hundred and fifty-six patients in the conventional group (from January 1, 2015 to December 31, 2017) and 442 patients from the ERAS group (from January 1, 2018 to June 1, 2020) were compared. Patients were followed for 1 year postoperatively.
Intervention
Changes were made in the preoperative, operative, postoperative, and outpatient follow-up settings after transplantation.
Outcome Measurements and Statistical Analysis
Primary endpoints were hospital length of stay (LOS) and 30-day readmission rates. We also measured surgical outcomes, graft performance, and patient survival. Wilcoxon rank-sum, Pearson's Chi-squared, or Fisher's exact tests were used to compare groups.
Results
Our ERAS protocol was associated with a decrease in hospital LOS from 5 to 3 days (p < 0.001) and 57.1% lower odds of hospital readmissions within 30 days compared to the conventional group (p < 0.001, 95% CI 0.26–0.7). Decreases in operative estimated blood loss, blood transfusion rates, and delayed graft function were also associated with the ERAS protocol.
Conclusion
Our multi-layered ERAS protocol is effective in improving outcomes for kidney transplant recipients. A future multi-institutional study with healthcare savings analysis may suggest that widespread benefits are yet to be realized by the greater implementation of such enhanced recovery protocols.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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