Abstract
Objective: To assess the impact of the implementation of an Enhanced Recovery After Surgery (ERAS) protocol in elective open simple nephrectomy in urolithiasis patients. Materials and Methods: Data from 43 patients were collated. Sixteen were in the ERAS group and 27 in the pre-ERAS group, the division created by date of the procedure. The ERAS protocol included preoperative education, standardized perioperative care, early mobilization, and postoperative pain management. Outcomes, including length of hospital stay (LOS), first flatus, first defecation, complications, pain scores, creatinine level (Cr), glomerular filtration rate (GFR) and associated costs, were compared. Results: The ERAS group exhibited significantly lower total LOS (3.19±0.40 days vs. 6.22±1.55 days, p < 0.001), earlier first flatus (1.19±0.40 days vs. 2.66±1.11 days, p < 0.001), first defecation (1.56±0.73 days vs. 3.11±1.28 days, p < 0.001), and lower postoperative ileus rates (12.5% vs. 71.43%, p = 0.01) than the control group. Lower pain scores at 1, 6, 24, and 48 hours post-surgery (p < 0.05) were also recorded in comparison to the control group. No significant differences in Cr and GFR were observed (p > 0.05). Although ERAS treatment costs were marginally lower, the difference was not statistically significant (23,833±3731.48 Baht vs. 23,930±3068.45 Baht, p = 0.927). Conclusion: ERAS implementation in elective open simple nephrectomy for urolithiasis reduces LOS, and postoperative pain, accelerates recovery of bowel function, and allows quicker resumption of normal activities. These benefits come without increased risk of readmission or complications, and without compromising postoperative renal function. All these advantages may also result in cost savings.
Published Version
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