title: Building the case for enhanced recovery protocols in living kidney donors.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI. 2 Department of Anesthesia, University of Michigan, Ann Arbor, MI.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waits
authors.forename: Paul
authors.initials: P
authors.lastname: Hilliard
authors.forename: Kyle H
authors.initials: KH
authors.lastname: Sheetz
authors.forename: Randall S
authors.initials: RS
authors.lastname: Sung
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002985:Clinical Protocols; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects; D009407:Nerve Block; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D015397:Program Evaluation; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D004040:Dietary Carbohydrates