Building the case for enhanced recovery protocols in living kidney donors.

BACKGROUND: Enhanced recovery protocols align with the current advantages of laparoscopic donor nephrectomy and may continue to decrease disincentives to donation.

METHODS: In this single-center retrospective analysis, we compare the outcomes of the first 60 living kidney donors enrolled in our enhanced recovery program (ERP) to those patients treated before implementation of the protocol. In addition to improved coordination of care, highlights of the ERP bundle included the use of transversus abdominus plane block, preoperative carbohydrate loading and narcotic free pain regimens. Chi-square and Student t test were used where appropriate.

RESULTS: Postoperative median length of stay decreased from 2.0 to 1.0 days (P<0.01) after protocol initiation. Overall narcotic use also decreased by nearly 50% (45.6 vs. 21.3; P<0.01), whereas pain scores remained similar (3.97 vs. 3.87; P=ns). Average time to incision was longer in the enhanced recovery group as compared to the standard protocol group (51 vs 42 min; P<0.05) by 9 min.

CONCLUSION: Implementation of an ERP for living kidney donors was associated with reduced LOS and decreased narcotic use after donor nephrectomy. This study suggests that ERPs may offer a framework for decreasing disincentives for donation and optimize patient satisfaction.