Freeman Hospital, UK.
Ann R Coll Surg Engl. 2023 Feb;105(2):166-172. doi: 10.1308/rcsann.2021.0365. Epub 2022 Apr 21.
Enhanced recovery after surgery (ERAS) is well established in many specialties but has not been widely adopted in renal transplantation. The aim of this survey was to understand current national practices and sentiment concerning ERAS for renal transplant recipients in the UK.
A national web-based survey was sent to consultant surgeons at all 23 UK adult renal transplant units. Completed questionnaires were collected between May and July 2020. Data were analysed according to individual responses and grouped according to the existence of formal ERAS pathways within units.
All transplant units were represented in this survey. Three units had a formal ERAS pathway for all recipients. Of the remaining units, 65.9% considered implementing an ERAS pathway in the near future. The most commonly perceived barrier to ERAS implementation was 'embedded culture within transplant units' (54.8% of respondents). A fifth of respondents insert surgical drains selectively and 11.7% routinely discontinue patient-controlled analgesia on postoperative day 1. Most respondents routinely remove urinary catheters on day 5 (70%) and ureteric stents 4-6 weeks post-transplantation (81.7%). Median length of stay for deceased donor kidney transplant recipients was lower in units with ERAS programmes (5-7 days versus 8-10 days, respectively). The main cited barriers for discharge were 'suboptimal fluid balance' and 'requirement of treatment for rejection'.
Despite slow uptake of ERAS in kidney transplantation, appetite appears to be increasing, particularly in the post-COVID-19 era. The current practice and opinions of transplant specialists highlighted in this survey may help to establish nationally agreed ERAS guidelines in this field.
加速康复外科（ERAS）在许多专科中得到了很好的应用，但在肾移植中尚未得到广泛应用。本调查的目的是了解英国肾移植受者 ERAS 的当前国家实践和意见。
对英国所有 23 个成人肾移植单位的顾问外科医生进行了全国性的网络调查。2020 年 5 月至 7 月期间收集了已完成的问卷。根据个人回复进行数据分析，并根据单位内是否存在正式的 ERAS 途径进行分组。
该调查涵盖了所有移植单位。有 3 个单位为所有受者制定了正式的 ERAS 途径。其余单位中，65.9%的单位考虑在不久的将来实施 ERAS 途径。实施 ERAS 的最常见障碍是“移植单位内部的既定文化”（54.8%的受访者）。五分之一的受访者选择性地插入外科引流管，11.7%的受访者常规在术后第 1 天停止患者自控镇痛。大多数受访者常规在第 5 天拔除导尿管（70%）和输尿管支架 4-6 周后（81.7%）。有 ERAS 方案的单位中，尸肾移植受者的住院时间中位数更短（分别为 5-7 天和 8-10 天）。出院的主要障碍是“液体平衡不佳”和“需要治疗排斥反应”。
尽管 ERAS 在肾移植中的应用进展缓慢，但这种方法的应用似乎在增加，尤其是在 COVID-19 之后。本调查中强调的移植专家的当前实践和意见可能有助于在该领域建立全国性的 ERAS 指南。
