Benefits of enhanced recovery after surgery in robotic nephrectomy

Abstract

Purpose: Enhanced recovery after surgery (ERAS) is an evidence-based perioperative care approach aimed at attenuating surgical stress response and facilitating patient recovery. This study compared postoperative outcomes between an ERAS perioperative model to a traditional, unstandardized perioperative care practice in patients undergoing robotic nephrectomy. Materials and methods: A total of 206 patients who underwent robotic renal surgery were stratified into traditional and ERAS cohorts. In total, 111 patients received the ERAS pathway, and 95 received traditional care. Data was collected through a retrospective review of electronic medical records. The primary outcome was length of hospital stay (LOS). The secondary outcomes included patient recovery milestones, pain scores, opioid use, patient complications, 30-day readmission rates, incidence of surgical site infection, and total hospital costs. Results: Implementation of the ERAS pathway was associated with shorter hospital stay (median LOS 2.2 days vs. 2.3 days p = 0.011), lower post-operative pain scores and lower total opioid requirements at all analyzed time points (0-1, 1-24, and 24-48 h). No statistically significant differences were observed in adverse events, rates of ileus, time to first flatus, surgical site infection, or oral intake. Hospital costs were similar between groups. 30-day readmission was higher in the traditional care cohort (9% vs. 2% p = 0.035). Conclusions: ERAS was associated with reduced length of hospital stay, improved pain scores, reduced opioid use, and lower incidence of hospital readmission in patients undergoing robotic nephrectomy.