Category: Laparoscopic/ Robotic: Other

MP17-19 - Impact of Implementation of Enhanced Recovery Protocol in patients undergoing Laparoscopic Nephrectomy, Open Nephrectomy and Nephroureterectomy

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

The benefits of Enhanced Recovery Programmes (ERPs) have been well established in major surgery.  However there is little literature on whether ERPs confer significant benefit for patients undergoing nephrectomy and nephroureterectomy.

Methods :

Patients undergoing nephrectomy or nephroureterectomy, at a district general hospital in the UK, between January 2014 and December 2017 were identified using theatre records.  Notes were reviewed retrospectively and data extracted regarding demographics, surgical details and complications, ASA grade, inpatient days, use of ERP and contact with ERP nurse.  In addition data were collected regarding achievement of ERP aims of —reduced use of drains, reduced use of urethral catheter , type of analgesia used, —contact with Pain Team, —use of pre-operative carbohydrate drinks, contact with physiotherary and standard level care —post-op ward.  Patients were excluded if a significant post-operative complication occurred.  Data were analysed using Microsoft Excel.

Results :

107 patients were identified, 21 were excluded due to post-operative complication, 86 cases were analysed.  No siginifcant differences between demographics of groups.  Regarding laparoscopic nephrectomy, 20 patients underwent the procedure without ERP and 29 with ERP, with mean length of stays 3.9 days and 2.4 days respectively (p<0.0005).  In this group the difference in use of pre-op drinks, physiotherapy involvement, use of urethral catheter, day of first mobilization were statistically significant ERP aims (p<0.05).  Regarding open nephrectomy and nephroureterectomy, 22 patients did not have ERP compared to 15 who did.  Mean length of stays were 4.6 days and 5.2 days respectively (p=0.16).

Conclusions :

We have demonstrated significantly reduced length of stay for patients undergoing laparoscopic nephrectomy if engaged with the ERP.  This has not been demonstrated in the cohort undergoing nephroureterectomy or open nephrectomy.  Pre-operative drinks, physiotherapy involvement and use of urethral catheter were the significant factors.

Narin Suleyman

Urology Registrar
Luton and Dunstable Hospital
Luton, England, United Kingdom

Miss Narin M Suleyman, BSc, MBBS, MRCS,. Luton and Dunstable Hospital. Specialist Registrar.

Aza Mohammed

Luton, England, United Kingdom

Barnaby Barrass

Luton, England, United Kingdom

Farooq Khan

Consultant Urological Surgeon
Luton and Dunstable Hospital
Luton, England, United Kingdom

Asad Saleemi

Consultant urological Surgeon, Department of Urology, Luton and Dunstable Hospital, Luton, UK
Luton, England, United Kingdom

Asher Alam

Luton, England, United Kingdom

Sanjeev Taneja

Luton, England, United Kingdom