Enhanced Recovery After Living Donor Nephrectomy: Reduced Opioid Use and Shorter Hospitalization in a Contemporary Cohort

Introduction This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) protocols on post-surgical outcomes following living donor nephrectomy (LDN). ERAS protocols are multimodal care pathways designed to reduce physiological stress postoperation, shorten hospital length of stay (LOS), and improve recovery. The study was conducted to evaluate the safety and effectiveness of implementing an ERAS protocol in LDN. Methods A retrospective single center cohort study was conducted, analyzing patients who underwent LDN between Jan 1, 2024 to December 31, 2024 at a high-volume transplant center. The study compared outcomes between patients who followed ERAS protocols and those who did not. Post donation length of stay, complications, and opioid use were measured. Results A total of 61 patients in the ERAS group and 53 in the pre-ERAS group were included. There were no significant differences in baseline characteristics between groups. Postoperative outcomes showed that the ERAS group had significantly lower post-op PCA use (10% vs 88%, P < .001), shorter median length of stay (1 day vs 2 days, P < .001), and lower total opioids on discharge (12 morphine milligram equivalents (MME) vs 112.5 MME, P < .001). The ERAS group had a lower rate of any complications (21.3% vs 30.2%, P = .36), less GI-related complications (8.1% vs 26.4%, P = .03), but similar postoperative infection (3.3% vs 3.8%, P = 1) and postoperative bleeding (1.6% vs 0%, P = 1) rates. Conclusion The study suggests that ERAS protocols significantly improve post-surgical outcomes following LDN, including reduced post-op PCA use, shorter hospital LOS, lower opioid use on discharge, and fewer complications. These findings support the implementation of ERAS protocols in LDN to enhance patient recovery and outcomes.