Fast-track open transperitoneal nephrectomy

OBJECTIVE: Hospital stay after open transperitoneal nephrectomy is usually 5-10 days, the limiting factors being pain, ileus, stress-induced organ dysfunction and fatigue. Recent studies have shown that aggressive multimodal rehabilitation may improve recovery and shorten hospitalization after other abdominal procedures. We therefore studied the effect of a multimodal rehabilitation regimen in patients undergoing open transperitoneal nephrectomy.

MATERIAL AND METHODS: A total of 25 consecutive patients scheduled for elective transperitoneal nephrectomy were studied after the introduction of a multimodal rehabilitation regimen (continuous epidural analgesia, enforced mobilization and oral nutrition and revision of the transurethral catheterization and drain regimen) and compared with 50 consecutive patients treated before the introduction of this regimen.

RESULTS: The multimodal rehabilitation regimen decreased hospital stay from 8 to 4 days (p < 0.001) with mobilization for approximately 6 h on the first postoperative day and 8 h on the second and third days. Use of a drain was shorter with the multimodal regimen (1 vs 4 days; p < 0.001), as was transurethral catheterization (1 vs 5 days; p < 0.001). "Medical" 30-day morbidity was low (6-8%) in both groups.

CONCLUSION: Our results suggest that a multimodal rehabilitation regimen with optimized pain relief, enforced mobilization, early oral nutrition and short-term transurethral catheterization and drain placement may reduce hospital stay after open transperitoneal nephrectomy.