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Purpose Enhanced Recovery After Surgery (ERAS) reduces postoperative complications and shortens hospital stays. We aimed to describe the implementation and improvement of ERAS protocols in our institution through a multidisciplinary team approach. Methods A multidisciplinary team comprised of colorectal surgeons, anesthesiologists, nurses, pharmacists, nutritionists, and a performance improvement team was launched to develop the ERAS protocol. The ERAS protocol was followed in patients who underwent colonic and rectal surgery between January and November 2017. The ERAS protocol comprised 22 elements in the preoperative, intraoperative, and postoperative phases. After the initial application, ERAS compliance was monitored and audited every 4–6 months and improvements made as necessary. Results The length of hospital stay significantly decreased after the application of the ERAS protocols for colon cancer in 2017 and 2018. And there was no significant difference in the duration of hospital stay after applying the rectal cancer ERAS protocol. Moreover, after starting the colon ERAS, there was a significant decrease in the complication rate. Since December 2017, there was a continuous increase in the colorectal ERAS clinical pathway application rate, which remained high (>90%). The patient compliance rate significantly increased between 2017 and 2018, but slightly decreased again in 2019. Conclusion The application and continual improvement of an ERAS protocol are crucial. Improving compliance may result in better clinical outcomes. Additionally, the basic guidelines of ERAS must be applied and developed according to each hospital’s situation based on the team approach.

Background: Living-donor kidney transplantation tend to be more common in Asian countries. Previous studies have shown that donor nephrectomy does not increase operation-related mortality or end-stage renal disease (ESRD) risks in usual healthy donors. However, these results were based on studies performed in western countries, and only few results have been reported in the Asian population including Korea. We aimed to analyze the short and long-term risks of living kidney donors in Korea. Methods: We retrospectively analyzed medical records of 1,352 patients who had undergone donor nephrectomy from August 2005 to December 2020 at Seoul St. Marys Hospital. We collected baseline characteristics such as obesity, hypertension, dyslipidemia, diabetes, and GFR. Immediate postoperative complications were graded according to the Clavien-Dindo classification. Hemoglobin, BUN, Cr, GFR, proteinuria, glucose, cholesterol, and triglyceride levels were assessed at regular follow-up intervals. Long-term mortality and incidence of comorbidities were also assessed. Results: Of the 1,352 patients, 740 patients had 5-year follow-up results, and 137 patients had 10-year follow-up results. Five (0.4%) patients had severe postoperative complications; one patient requiring ICU care due to postoperative bleeding. Before donation, 3.0% were hypertensive, 4.7% had dyslipidemia, and 0.1% were diabetic. After donation, 5.8% were hypertensive, 4.9% had dyslipidemia, and 0.1% had diabetes. All donors had eGFR above 60 mL/min/1.732 before nephrectomy, but 19.7% donors showed eGFR below 60 after long-term follow-up, and 4.9% reached eGFR below 40. No mortality or ESRD requiring hemodialysis were reported during follow-up. Conclusions: Donor nephrectomy is a safe procedure with low risk of operation related complications. There was no significant difference in renal function, or cardiovascular comorbidities in donors compared to the healthy population. Limitations of our study was that the donors were from a single center, and many were lost during follow-up. Further studies including data from donors before 2005 may show additional outcomes, on mortality and renal failure.