Positive Impact of ERAS Programme on Living and Deceased Donor Renal Transplant Recipients During COVID-19 Pandemic

Abstract

Background: Enhanced Recovery After Surgery (ERAS) programmes have been introduced in many surgical specialties to effectively reduce length of stay (LOS) while maintaining safe care. We implemented an ERAS programme in order to minimise the risk of nosocomial COVID-19 transmission through a shorter Hospital stay. Method(s): A protocol was implemented after a literature review and finalised in MDT discussion and then distributed to wards with informative posters (Figure 1 ERAS bedside checklist). Patients on the renal transplant waiting list were provided with detailed information about the programme and received prehab and post-op exercise advice. The primary outcome was Hospital LOS with secondary outcomes including opiate use, level of mobilisation, bowel function and patient reported outcomes. Compliance to the ERAS protocol was monitored and recorded prospectively. The ERAS patients (n = 28) were compared with a historical control group of 25 consecutive patients transplanted 12 months previously (pre-ERAS patients). Data were analysed in GraphPad Prism and groups compared with student t-test and Chi2 test. Result(s): Since December 2020, 28 recipients completed the ERAS recovery protocol. The baseline characteristics of this group were comparable with pre-ERAS patients. Median LOS was significantly reduced in the ERAS group (5 days) compared to the pre-ERAS group (8 days, P = 0.01). 54% of ERAS patients were discharged within 5 days compared with only 8% in the pre-ERAS group (X2 12.59, P < 0.001). For those with stays longer than the target 5 days, 33% had graft issues e.g. need for biopsy but there were also potential preventable reasons including medication education and delayed physiotherapy input. ERAS had a positive impact on time to 1st bowel movement and was associated with reduced opiate use. 79.2% of recipients mobilised on day 1 post-op with either physiotherapy or nursing staff. Only one ERAS recipient was readmitted after discharge and only one patient required recatheterisation. Conclusion(s): Introduction of an ERAS programme successfully reduced the median length of stay by 2.5 days and had a positive impact on patient care and minimal adverse events. It is hypothesised that appointment of a specialist ERAS nurse is likely to improve compliance and effectiveness and plans are in place to appoint.