scholarly journals SP5.2.2 A Systematic Review of Living Kidney Donor Enhanced Recovery After Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Matthew Byrne ◽  
Ahmed Mehmood ◽  
Dominic Summers ◽  
Sarah Hosgood ◽  
Michael Nicholson
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Living Donor ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Donor Nephrectomy ◽  
Live Donor ◽  
Live Donor Nephrectomy ◽  
Living Donor Nephrectomy ◽  
Significant Difference

Abstract Background Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stays without increasing readmission or mortality. However, its role in living donor nephrectomy has not yet been defined. This systematic review aimed to describe the literature on ERAS in live donor nephrectomy. Methods Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 1/7/19 for all original randomised control and cohort studies relating to ERAS in living donor nephrectomy. The study was registered on PROSPERO (CRD: CRD42019141706). Results 1248 patients were identified from 14 studies (630 patients with ERAS and 618 patients without). There were considerable differences in the protocols used and compliance with general ERAS recommendations was poor. Meta-analysis revealed that with ERAS length of stay significantly reduced by 0.83 days (95% CI = 0.30-1.37, p = 0.002), there was a trend towards decreased readmission (OR = 0.45, 95% CI = 0.19=1.10, p = 0.08), and there was no significant difference in complications (OR = 0.73, 95% CI 0.16-3.39, p=0.69). Opiate usage was significantly reduced with ERAS in all studies that measured it and there was no significant difference in creatine clearance. Conclusions ERAS in live donor nephrectomy significantly reduces length of stay, and reduces opiate usage, without increasing readmission, complications, or creatinine. There is considerable variation in ERAS protocols used and a guideline for ERAS in live donor nephrectomy should be developed.

scholarly journals Feasibility, Safety and Efficacy of Enhanced Recovery after Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 10 (1) ◽  
pp. 21
Author(s):  
Apostolos Prionas ◽  
Charles Craddock ◽  
Vassilios Papalois
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Living Donor ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Donor Nephrectomy ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Living Donor Nephrectomy

This meta-analysis aims to compare enhanced recovery after surgery (ERAS) vs. standard perioperative practice in the management of living kidney donors. Primary endpoints included mortality, complications, length of stay (LOS) and quality of life after living donor nephrectomy. Medline, Embase, Scopus, Cochrane and Web of Science databases were searched. In total, 3029 records were identified. We then screened 114 full texts. Finally, 11 studies were included in the systematic review corresponding to 813 living donors. Of these, four randomized controlled trials were included in the meta-analysis. ERAS resulted in shorter LOS (95CI: −1.144, −0.078, I2 = 87.622%) and lower incidence of post-operative complications (95CI: 0.158, 0.582, I2 = 0%). This referred to Clavien–Dindo I-II complications (95CI: 0.158, 0.582, I2 = 0%). There was no difference in Clavien–Dindo III-V complications (95CI: 0.061,16.173, I2 = 0%). ERAS donors consumed decreased amounts of narcotics during their hospital stay (95CI: −27.694, −8.605, I2 = 0%). They had less bodily pain (95CI: 6.735, 17.07, I2 = 0%) and improved emotional status (95CI: 6.593,13.319, I2 = 75.682%) one month postoperatively. ERAS protocols incorporating multimodal pain control interventions resulted in a mean reduction of 1 day in donors’ LOS (95CI: −1.374, −0.763, I2 = 0%). Our results suggest that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy.

Protocol Based Reduction in Narcotic Use and Length of Stay Following Robotic Live Donor Nephrectomy.

2014 ◽  
Vol 98 ◽  
pp. 602
Author(s):  
M. Mulloy ◽  
R. Cross ◽  
M. Tan ◽  
M. Sellers ◽  
M. Johnson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Donor Nephrectomy ◽  
Live Donor ◽  
Live Donor Nephrectomy

Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

2019 ◽  
Vol 35 (09) ◽  
pp. 695-704 ◽  
Author(s):  
Carol E. Soteropulos ◽  
Sherry Y.Q. Tang ◽  
Samuel O. Poore
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Breast Reconstruction ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Management ◽  
Patient Counseling ◽  
Opioid Use ◽  
Full Spectrum ◽  
Alloplastic Breast Reconstruction

Background Enhanced Recovery after Surgery (ERAS) principles have received focused attention in breast reconstruction. Many protocols have been described in the literature for both autologous and alloplastic reconstruction. This systematic review serves to better characterize successful ERAS protocols described in the literature for potential ease of adoption at institutions desiring implementation. Methods A systematic review of ERAS protocols for autologous and alloplastic breast reconstruction was conducted using Medline, the Cochrane Database, and Web of Science. Results Eleven cohort studies evaluating ERAS protocols for autologous (n = 8) and alloplastic (n = 3) breast reconstruction were included for review. The majority compared with a retrospective cohort of traditional perioperative care. All studies described the full spectrum of implemented ERAS protocols including preoperative, intraoperative, and postoperative phases of care. Most frequently reported significant outcomes were reduced length of stay and opioid use with ERAS implementation. No significant change in major complication or readmission rate was demonstrated. Conclusion Based on this systematic review, several core elements that make up a successful perioperative enhanced recovery protocol for breast reconstruction have been identified. Elements include patient counseling and education, limited preoperative fasting, appropriate thromboprophylaxis and antibiotic prophylaxis dependent on reconstructive method, preoperative antiemetics, multimodal analgesia and use of local anesthetic, goal-directed intravenous fluid management, prompt removal of drains and catheters, early diet advancement, and encouragement of ambulation postoperatively. Implementation of ERAS protocols in both autologous and alloplastic breast reconstruction can positively enhance patient experience and improve outcomes by reducing length of stay and opioid use, without compromising successful reconstructive outcomes.

Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis

2014 ◽  
Vol 115 (2) ◽  
pp. 206-215 ◽  
Author(s):  
Riccardo Autorino ◽  
Luis Felipe Brandao ◽  
Bashir Sankari ◽  
Homayoun Zargar ◽  
Humberto Laydner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Living Donor ◽  
Meta Analysis ◽  
Donor Nephrectomy ◽  
Single Site ◽  
Laparoendoscopic Single Site ◽  
Living Donor Nephrectomy

scholarly journals Right Kidney Mini-Invasive Living Donor Nephrectomy: A Safe and Efficient Alternative

2020 ◽  
Vol 104 (11-12) ◽  
pp. 859-864
Author(s):  
Lucas Broudeur ◽  
Georges Karam ◽  
Reshma Rana Magar ◽  
Pascal Glemain ◽  
Thomas Loubersac ◽  
...  
Keyword(s):  
Living Donor ◽  
Left Kidney ◽  
Graft Function ◽  
Donor Nephrectomy ◽  
Safe Procedure ◽  
Conversion To Open Surgery ◽  
Living Donor Nephrectomy ◽  
Donor Safety ◽  
Living Donor Transplantation ◽  
Significant Difference

<b><i>Introduction:</i></b> Right kidney living donor transplantation is considered more difficult and associated with more complications. The objective was to evaluate donor safety and graft function of right hand-assisted laparoscopic donor nephrectomy (HALDN). <b><i>Methods:</i></b> A total of 270 consecutive HALDN procedures have been performed in our institution up to April 2017. We retrospectively compared the outcomes of right-sided nephrectomy (R-HALDN) to left-sided nephrectomy (L-HALDN) to evaluate donor safety and graft function of R-HALDN. <b><i>Results:</i></b> Sixty-seven right kidneys were removed for functional asymmetry in favour of left kidney (35/67) or left kidney multiple arteries (28/67). Among the donors, neither conversion to open surgery nor preoperative blood transfusion was necessary. There was no significant difference in operative time, compared to L-HALDN group (170 ± 37 min vs. 171 ± 32 min; <i>p</i> value = 0.182). Warm ischaemia time was significantly longer for R-HALDN (4.0 ± 1.6 min vs. 3.0 ± 1.7 min; <i>p</i> &#x3c; 0.001). There was no significant difference in terms of post-operative complications and serum Cr levels. Among the recipients, there were no graft venous thrombosis. There was no significant difference in delayed graft function (3 for R-HALDN group and 8 for L-HALDN group; <i>p</i> value = 0.847), serum Cr levels, and graft survival. <b><i>Conclusion:</i></b> R-HALDN is a safe procedure for kidney donors, with excellent graft function for the recipients, compared to L-HALDN.

scholarly journals Introduction of an enhanced recovery protocol into a laparoscopic living donor nephrectomy programme

2020 ◽  
Vol 102 (3) ◽  
pp. 204-208 ◽  
Author(s):  
T Brown ◽  
F Magill ◽  
N Beckett ◽  
S Kanabar ◽  
J Monserez ◽  
...  
Keyword(s):  
Living Donor ◽  
Enhanced Recovery ◽  
Postoperative Recovery ◽  
Donor Nephrectomy ◽  
Fluid Restriction ◽  
Potential Donor ◽  
Living Donor Nephrectomy ◽  
Pain Scores ◽  
Enhanced Recovery Protocol ◽  
The Impact

Introduction Living-donor renal transplantation is the optimal treatment for patients with end-stage renal disease. The rate of living donation in the UK is sub-optimal, and potential donor concerns regarding postoperative recovery may be contributory. Enhanced recovery programmes are well described for a number of surgical procedures, but experience in living-donor surgery is sparse. This study reports the impact of introducing an enhanced recovery protocol into a living-donor renal transplant programme. Materials and methods All consecutive patients undergoing laparoscopic living-donor nephrectomy over a 25-month period were included. The principles of enhanced recovery were fluid restriction, morphine sparing and expectation management. Outcome measures were postoperative pain scores and complications for donor and recipients. Results Standard care was provided for 24 (30%) patients and 57 (70%) followed an enhanced recovery pathway. The latter group received significantly less preoperative intravenous fluid (0ml vs 841ml p < 000.1) and opiate medication (14.83mg vs 23.85mg p = 0.001). Pain scores, postoperative complications and recipient transplant outcomes were comparable in both groups. Conclusions Enhanced recovery for living-donor nephrectomy is a safe approach for donors and recipients. Application of these techniques and further refinement should be pursued to enhance the experience of living donors.

scholarly journals Impact of Right-Sided Nephrectomy on Long-Term Outcomes in Retroperitoneoscopic Live Donor Nephrectomy at Single Center

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Kazuya Omoto ◽  
Taiji Nozaki ◽  
Masashi Inui ◽  
Tomokazu Shimizu ◽  
Toshihito Hirai ◽  
...  
Keyword(s):  
Graft Survival ◽  
Graft Function ◽  
Renal Vein Thrombosis ◽  
Donor Nephrectomy ◽  
Live Donor ◽  
Ischemic Time ◽  
Vein Thrombosis ◽  
Live Donor Nephrectomy ◽  
Significant Difference

Objective.To assess the long-term graft survival of right-sided retroperitoneoscopic live donor nephrectomy (RPLDN), we compared the outcomes of right- and left-sided RPLDN.Methods.Five hundred and thirty-three patients underwent live donor renal transplantation with allografts procured by RPLDN from July 2001 to August 2010 at our institute. Of these, 24 (4.5%) cases were selected for right-sided RPLDN (R-RPLDN) according to our criteria for donor kidney selection. Study variables included peri- and postoperative clinical data.Results.No significant differences were found in the recipients' postoperative graft function and incidence of slow graft function. Despite significant increased warm ischemic time (WIT: mean 5.9 min versus 4.7 min, ) in R-RPLDN compared to that in L-RPLDN, there was no significant difference between the two groups regarding long-term patient and graft survival. The complication rate in R-RPLDN was not significantly different compared to that in L-RPLDN (17% versus 6.5%, ). No renal vein thrombosis was experienced in either groups.Conclusions.Although our study was retrospective and there was only a small number of R-RPLDN patients, R-RPLDN could be an option for laparoscopic live donor nephrectomy because of similar results, with the sole exception of WIT, in L-RPLDN, and its excellent long-term graft outcomes.

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