Year: 2024
Type: article
Abstract: techniques can improve patient outcomes in donor nephrectomies. 1 2 The Donor Nephrectomy Improvement Programme at the Queen Elizabeth University Hospital is a multiphase quality improvement project, started in 2016, with the aim to improve patient outcomes.Over 7 yr and four phases, it has led to the formation of the current anaesthetic guidelines.Methods: Donor nephrectomy patients were identified from the transplant coordinator log.A chronic pain diagnosis or opioid use were exclusion criteria.The exact anaesthetic technique including perioperative analgesics and postoperative prescription was retrospectively recorded.The main outcomes were pain scores, postoperative opioid use, day of mobilisation (DoM), and length of hospital stay (LoS).Initially, the best performing anaesthetists' techniques were compared with those of poorer performing anaesthetists to inform new guidance for the subsequent phase.This anaesthetic technique guidance evolved, informed from the analysis of the previous phase, for each subsequent phase.Phase 4 (2020e3) also marked the introduction of ERAS guidance designed by transplant surgeons.Results: We included 237 donor nephrectomy patients with full clinical records over four phases.There was a reduction in the incidence of pain scores >4, and a large stepwise reduction in the first 48-h opioid use by 71 mg (89%) from phase 1 to phase 4 (Fig. 17).ERAS guidelines introduced for phase 4 also contributed to a notable reduction in LoS by 1.3 days (31%) and DoM by 1.4 days (58%) compared with phase 1. Between anaesthetists, a direct relationship between compliance with the guideline and lower opioid use and pain scores exists.In left-sided donors, there was no statistical difference between rectus sheath and erector spinae plane catheters for pain scores or i.v.opioid use.
Source: BJA Open
Author: Caolan Stowe
Institution: Royal Oldham Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,870
OpenAlex ID: W4403289030