Laparoscopic/ Robotic: Other
Moderated Poster Session
MP17-18 - Enhanced recovery program (ERP) for laparoscopic nephrectomies /nephrouretrectomies: is it a fashion or work on progress?
Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 252B
Introduction & Objective :
The British Association of Urological Surgeons (BAUS) developed the ERP for urological surgery in 2015. Care pathway through standardised protocols, aims to achieve a faster return to normality after surgery. Our local protocols in laparoscopic nephrectomies (LN) & nephrouretrectomies (LNU) have shown significant progress in terms of patients’ recovery & reduction in the length of stay (LOS). Does a formal ERP make a difference in these group of patients, considering their very short LOS and little or no starvation or bowel resting? In this study we report our current practice and highlight similarities and dissimilarities to BAUS ERP following LN & LNU by a single surgeon in our institution.
A retrospective study of patients who underwent LN & LNU at Milton Keynes University Hospital (MKUH) from 2015 to April 2018 was carried out. 49 patients (m=24, f=25), mean age of 63.1 (± 14.0) years was included. Compliance with ERP recommendations was assessed pre-operatively (PRO), intra-operatively (IOP) and post-operatively (POO). Secondary outcomes included conversion to open surgery (COS) and LOS, blood transfusion, Clavien Dindo grade (CDG) of POO complications and 30 day mortality.
All patients were optimized as per BAUS at PRO, except carbohydrate pre-loading (0%) Analgesics recommendations were adhered to 100%, 85.4% received morphine IOP. 23.1% received antacids at induction, & 100% POO. Antiemetics use was 93.1% IOP & 96.6% POO. All patients had local anaesthesia IOP, 27.6% had regional blocks. All patients had a urethral catheter inserted. 67.3% were removed POO day 1. Drains were inserted in 98.2%, 73.1% removed day 1 POO. The median LOS has reduced from 2 nights to 1 night in the latter half of the LN patients; and from 3 nights to 2 nights in the LNU patients. other secondary outcomes include, 0% conversion to open surgery, and 0% transfusion rate, 0% mortality rate (30 day). CDG I compllications are minor in 30% of our case series.
Our continually improving successes with LN and LNU cannot be attributed to strict compliance with BAUS ERP. Our local protocols especially local anaesthetic infusion for pain relief and avoidance of opiates are chief factors. A dedicated team including physiotherapists and pain specialists and pre-op team drive the success rather than a strict adherence to ERP protocol. Each patient care must be individualised, and departmental experiences shared across regions. .