A systematic review of living kidney donor enhanced recovery after surgery.
Matthew Henry Vincent ByrneAhmed MehmoodDominic M SummersSarah A HosgoodMichael L NicholsonPublished in: Clinical transplantation (2021)
Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stay without increasing readmission or mortality. However, its role in living donor nephrectomy (LDN) has not yet been defined. Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 08/01/21 for all randomized controlled and cohort studies comparing ERAS to standard of care in LDN. The study was registered on PROSPERO (CRD: CRD42019141706). One thousand, three hundred seventy-seven patients were identified from 14 studies (698 patients with ERAS and 679 patients without). There were considerable differences in the protocols used, and compliance with general ERAS recommendations was poor. Meta-analysis of laparoscopic procedures (including hand- and robot-assisted) revealed that duration of stay was significantly reduced by 0.98 days with ERAS (95% CI = 0.36-1.60, P = .002) and opiate requirement by 32.4 mg (95% CI = 1.1-63.7, P = .04). There was no significant difference n readmission rates or complications. Quality of evidence was low to moderate assessed using the GRADE tool. This review suggests there is a positive benefit of ERAS in laparoscopic LDN. However, there was considerable variation in ERAS protocols used, and the quality of evidence was low; as such, a guideline for ERAS in LDN should be developed and validated.
Keyphrases
- robot assisted
- end stage renal disease
- newly diagnosed
- ejection fraction
- healthcare
- minimally invasive
- chronic kidney disease
- prognostic factors
- quality improvement
- peritoneal dialysis
- palliative care
- clinical trial
- type diabetes
- double blind
- randomized controlled trial
- single cell
- patient reported outcomes
- electronic health record
- clinical practice
- patient reported
- adverse drug
- pain management
- study protocol
- acute care
- case control