Objective: Implementation of enhanced recovery (ER) protocols can improve perioperative outcomes in multiple surgical specialties, however limited data exist on using ER protocols in patients undergoing kidney transplantation. The objectives of this study were to develop a multidisciplinary ER protocol for patients undergoing single organ kidney transplants and measure the impact of a pilot implementation.
Methods: Retrospective review of pre- and post-intervention outcomes at a single institution between January, 2015 and July, 2016. All patients receiving a single organ kidney transplant over the age of 18 were included. Project was conducted in two stages. Stage 1 was a multidisciplinary gap analysis using a modified Delphi approach to define a consensus ER protocol. Stage 2 was a 9-month pilot implementation. Prospective observational analysis performed with postoperative LOS identified as the primary outcome.
Results: A total of 66 patients were included for study, 18 prior to intervention and 48 following intervention. Mean age of the study population was 49.8±12.9 years (49.5+16.6 years pre-ER and 50.0±11.4 years post-ER, P=.899). Gap analysis led to the development of an ER protocol based on 3 domains: (1) standardization of postoperative pathways, (2) early mobilization, (3) patient engagement. Following implementation, postoperative length of stay decreased from 7.5±4.0 days to 4.9±2.0 days (P<.001).
Conclusion: Implementation of a locally-developed ER protocol can reduce LOS in patients undergoing kidney transplant. Based on pilot data and institutional transplant volume, this ER protocol could generate cost savings that exceed $950,000 annually.
