Presentation Authors: Daniel Swredloff*, Ablany, NY, Rachel Smith, Kanwaldeep K Williams, Paul Feustel, Michael Swerdloff, Albany, NY, Donald Lee, Ablany, NY, Demetri Podolski, Igor Galay, Ronald Kaufman, Albany, NY
Introduction: Enhanced Recovery After Surgery (ERAS) protocols are the new topic of interest among various surgical subspecialties. ERAS gives surgeons a dedicated pathway, no matter the surgeon or institution. Though treatment algorithms vary across specialties, the aim is identical: accelerate recovery time, thereby reducing the hospital length of stay. Within Urology, ERAS protocols are used with radical cystectomy patients. There is little evidence that looks at the application of ERAS protocol in renal surgery patients. We sought to implement an ERAS protocol in this patient population. The aim of this study is to report initial results.
Methods: A retrospective analysis was performed comparing patients who underwent renal surgery prior to and after implementation of ERAS. The ERAS team is a multidisciplinary team composed of perioperative nurses, anesthesiologists and urologists. In the pre-operative period, patients were given detailed instructions and expectations. On the morning of their surgery, they were provided with a standardized set of multimodal antiemetic and analgesic prophylactics, taking weight, GFR and type of surgery into consideration, and they remained on this pathway until discharge.
Results: There were 76 patients in the pre-ERAS group and 42 in the ERAS group. Median length of stay (LOS) in the pre-ERAS vs ERAS group was 3 days vs 2 days (p < 0.005). For open procedures, median LOS was 5 days vs 2 days (p < 0.001). For robotic procedures, median LOS decreased from 3 days to 2 days (p < 0.001). Median LOS was lower in the ERAS group independent of Age, Sex, BMI, ASA score and Anesthesia time. For the purposes of pain control analysis, all oral pain medications were converted to their oxycodone equivalent and all IV pain medications were converted to their morphine equivalent. Median total oxycodone went from 52.5mg to 8.75mg (p < 0.005) and median total morphine went from 4mg to 0 (p < 0.005). Thirty day readmission rate in the pre-ERAS group was 13.2% and 16.7% in the ERAS group (p = 0.558). The average total cost per patient decreased from $23,379 pre-ERAS to $16,908 in the ERAS group. A NSQIP sampling of pre-state patients showed a complication rate of 18.9% and 17.4% in the ERAS group.
Conclusions: ERAS works well for renal surgery patients. It significantly decreased overall length of stay and hospital cost, without having a significant effect on readmission rate.