title: Subjective and objective comparison of critical care pathways for open donor nephrectomy.
abstract: OBJECTIVE
  In the era of minimally invasive techniques and cost containment, care pathways after donor nephrectomy are important. While open donor nephrectomy remains the established procedure, questions regarding the surgical approach, postoperative care and patient morbidity/dissatisfaction have surfaced. We compared results of standard and fast-track care pathways after donor nephrectomy.
  
  
  METHODS
  Between January 1998 and August 1999, 60 patients underwent open donor nephrectomy. By surgeon preference, patients received either ketorolac only (31), ketorolac plus morphine spinal (17) or patient controlled anesthesia (12). Data related to surgery, hospital course and cost were reviewed. Patients were surveyed regarding return to daily activities and groups were statistically analyzed.
  
  
  RESULTS
  The mean dose per patient was 183 (ketorolac only), 180 (ketorolac plus morphine spinal) and 69 (patient controlled analgesia) mg. Median hospital stay was 2 days for the fast-track pathways (ketorolac only, ketorolac plus morphine spinal) compared to 3 days for the patient controlled analgesia group (p <0.001). Delayed oral intake was seen in 6% of patients on ketorolac only and 3% for those on ketorolac plus morphine spinal compared to 83% of the patient controlled analgesia group (p <0.001). Return to exercise (median weeks, p <0.79) was 2 for the ketorolac only group, 3.5 for ketorolac plus morphine spinal and 3.5 for patient controlled analgesia. Mean global cost was $9,394 for the ketorolac only group, $9,238 for ketorolac plus morphine spinal and $11,601 for patient controlled analgesia (p <0.02).
  
  
  CONCLUSIONS
  Fast-track pathways significantly shortened hospital stay and quickened oral intake. Cost was significantly contained using new pathways. Resumption of daily activities was comparable among the groups. Comparisons of critical care pathways are required to optimize patient care after kidney donation. Prospective trials are needed to verify our results.
authors: Department of Urology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55901, USA.
authors: Melinda K
authors: MK
authors: Knight
authors: David S
authors: DS
authors: DiMarco
authors: Robert P
authors: RP
authors: Myers
authors: Matthew T
authors: MT
authors: Gettman
authors: Mercedeh
authors: M
authors: Baghai
authors: Donald
authors: D
authors: Engen
authors: Joseph W
authors: JW
authors: Segura
mesh_terms: D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000191:economics; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000191:economics; D003365:Costs and Cost Analysis; D019091:Critical Pathways; D006801:Humans; D007273:Injections, Intramuscular; D020910:Ketorolac / Q000008:administration & dosage / Q000191:economics; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D019520:Living Donors; D009020:Morphine / Q000008:administration & dosage / Q000191:economics; D009392:Nephrectomy / Q000191:economics / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000191:economics / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D020910:Ketorolac