LAUSR

An ERAS (Enhanced Recovery After Surgery) programme was created to reduce length of stay (LoS) and improve outcomes following renal transplant surgery. This aimed to reduce post-operative hospital-acquired infection, especially COVID-19. The ERAS protocol was finalised following a literature review and MDT discussion. ERAS information, with post-operative exercise advice, was distributed to patients on the renal transplant waitlist. LOS was evaluated, comparing ERAS with pre-ERAS recipients and, to remove pandemic bias, pre-pandemic (December 2019) recipients. Secondary outcomes were opiate use, mobilisation, bowel function and patient-reported outcomes. ERAS protocol compliance was monitored. Data analysis was with student t-test and Chi-2 test in GraphPad Prism. Some 35 consecutive recipients completed ERAS protocol (March 2021). Baseline characteristics were comparable between live-donor recipients 9/35 vs 13/35 pre-ERAS and 12/35 pre-COVID. BMI>30 was higher in ERAS group (19vs. 11vs. 8). Median LoS was significantly reduced: ERAS - 5 days, pre-ERAS - 7 days, pre-COVID - 8 days (p=0.01). 51% of ERAS discharges were within 5 days vs. 17% pre-ERAS vs. none pre-COVID (X2 12.59, p<0.001). For overstayers (>5 days), potential preventable reasons were identified. 79.2% of ERAS recipients mobilised on day 1 post-op. ERAS indicated no significant reduced opiate use. Two ERAS recipients were readmitted within 30 days (vs.9/70 pre-ERAS) and one returned to theatre (vs.5/70 pre-ERAS). This ERAS programme successfully reduced the LoS by 2 days in comparative population with minimal adverse events. Patient and staff feedback was positive. It's hypothesised that assigning a specialist ERAS nurse will improve compliance.