Elsabbagh Ahmed M, Ghoneim Islam, Moiz Abdul, Welch Kristen, Brown J Sidni
St Vincent Abdominal Transplant Center, St Vincent Hospital, Indianapolis, IN.
Department of Surgery, Mansoura University, Mansoura, Egypt.
Transplant Direct. 2022 Jun 17;8(7):e1333. doi: 10.1097/TXD.0000000000001333. eCollection 2022 Jul.
Enhanced recovery after surgery (ERAS) pathway is a multimodal perioperative care pathway designed to achieve early recovery after surgery. ERAS protocols have not yet been well recognized in kidney transplantation. The aim of this study was to investigate the impact of ERAS pathway on early recovery and short-term clinical outcomes of kidney transplant.
This is a single-center retrospective analysis comparing the outcomes of 20 adult kidney transplant recipients subjected to ERAS pathway with 20 adult recipients operated before ERAS with traditional standard of care.
There were no significant differences between both groups regarding age, gender, race, dialysis status, living donor percentage, cold ischemia time, and warm ischemia time. Median hospital stay for ERAS patients was 2 d. Overall median pain scores were significantly lower in the ERAS group versus non-ERAS group (morning after surgery pain score 2 versus 5; peak pain score 4.5 versus 10; lowest pain score 0 versus 2; = 0.0001). ERAS patients had earlier ambulation (walking) and oral nutrition (regular diet) (first versus second day postoperatively in traditional group). Earlier bowel movement was observed in ERAS patients. There were no significant differences in graft function or 30-d readmission rates between both groups.
Implementation of ERAS pathway in kidney transplantation is feasible. Using ERAS is associated with less pain, earlier ambulation and advancement of oral nutrition, and short hospital stay.
术后加速康复（ERAS）路径是一种多模式围手术期护理路径，旨在实现术后早期康复。ERAS方案在肾移植中尚未得到充分认可。本研究的目的是探讨ERAS路径对肾移植早期康复和短期临床结局的影响。
这是一项单中心回顾性分析，比较了20例接受ERAS路径的成年肾移植受者与20例在ERAS实施前接受传统标准护理手术的成年受者的结局。
两组在年龄、性别、种族、透析状态、活体供者比例、冷缺血时间和热缺血时间方面无显著差异。ERAS组患者的中位住院时间为2天。ERAS组的总体中位疼痛评分明显低于非ERAS组（术后次日晨疼痛评分2分对5分；疼痛峰值评分4.5分对10分；最低疼痛评分0分对2分；P = 0.0001）。ERAS组患者更早开始活动（行走）和经口营养（正常饮食）（传统组为术后第一天对第二天）。ERAS组患者排便更早。两组之间的移植肾功能或30天再入院率无显著差异。
在肾移植中实施ERAS路径是可行的。采用ERAS与疼痛减轻、更早活动和经口营养进展以及住院时间缩短相关。
