An enhanced recovery after surgery protocol in children who undergo nephrectomy for Wilms tumor safely shortens hospital stay

Background: Pediatric unilateral renal tumors in the US are treated with upfront nephrectomy and surgi-cal staging. We applied enhanced recovery after surgery (ERAS) principles in care of children after Wilms nephrectomy.Methods: We reviewed records of pediatric unilateral nephrectomies for Wilms tumors, and analyzed tu-mor stage, surgical approach, length of operation, use of anesthesia adjuncts and catheters, diet advance-ment, hospital length of stay (LOS), and complications. Our ERAS protocol includes: parental education regarding discharge criteria and anticipated LOS, avoiding thoraco abdominal incisions, avoiding routine nasogastric tubes, clear liquids starting day of surgery, minimizing opiates, routine IV ketorolac use, and avoiding routine ICU stay. We examined the effects of our protocol on postoperative hospital LOS and complication rates.Results: Sixty six children (31 boys, mean age 3.8y, range 0-11.9) underwent unilateral total nephrec-tomy for Wilms tumor. Mean nephrectomy duration was 2.7 h. Post operatively, seven (11%) had tem-porary gastric tubes and 24 (36%) had epidural catheters. Ten (15%) recovered in the ICU. Patients were given regular diets mean of 1.9 days post op. Mean LOS was 3.7 days, with 56% of patients being dis-charged within 2-3 days. Presence of tumor thrombus, longer epidural catheter duration, delayed diet advancement, and total IV narcotic usage were associated with longer LOS. Routine use of IV ketorolac was associated with shorter LOS.Conclusions: Use of an ERAS protocol in children undergoing nephrectomy for Wilms tumor is safe, re-sulting in rapid return to regular diet and compared to the published literature, shorter postoperative LOS without an increase in complications or return to ED/OR. Level of evidence: Level III (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

The use of an ERAS protocol in children undergoing nephrectomy for Wilms tumor is safe and results in rapid return to regular diet. It also leads to shorter postoperative hospital stay without increased complications or return to the emergency department or operating room.