Randomized control trial on perioperative antibiotic prophylaxis in live liver donors: Are three doses enough?

Gupta, Sahil; Sinha, Piyush Kumar; Patil, Nilesh; Mohapatra, Nihar; Sindwani, Gaurav; Garg, Neha; Khillan, Vikas; Pamecha, Viniyendra

doi:10.1002/jhbp.1053

Cited by 3 publications

(6 citation statements)

References 31 publications

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“…All the donors with intestinal obstruction were in group B. Median day of drain removal in EDR group was 3 and RDR group was 5 (3 (3-33) Vs 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), P = 0.021). Out of 54 donors in group EDR, 8 donors didn't undergo drain removal on POD 3 as per protocol, they all were included in intention to treat -ITT analysis.…”

Section: Post Operative Parametersmentioning

confidence: 99%

Early drain removal after live liver donor hepatectomy is safe - A randomized control trial

Durairaj

Pamecha

Mohapatra

et al. 2022

Preprint

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INTRODUCTION: The aim of current study was to assess safety of early drain removal after live donor hepatectomy (LDH). METHODS: 108 consecutive donors who met the inclusion criteria, were randomized to Early Drain Removal (EDR – post operative day (POD) 3 - if serous and the drain bilirubin level was less than 3 times of serum bilirubin - “3x3” rule) and Routine Drain Removal (RDR – drain output serous and less than 100ml). Primary outcome was to compare the safety. Secondary outcomes was to compare the post-operative morbidity. RESULTS: Pre-operative, intra-operative and postoperative parameters except for timing of drain removal were comparable. EDR was feasible in 46 out of 54 donors (85.14%) and none required re-intervention after EDR. There was significantly better pain relief with EDR (p=0.00). Overall complications, pulmonary complications, and hospital stay were comparableon intention-to-treat analysis. However, pulmonary complications (EDR - 1.9% Vs RDR -16.3% P= 0.030), overall complications (18.8% Vs 36.3%, P= 0.043) and hospital stay (8 Vs 9, P= 0.014) were more in RDR group on per treatment analysis. Bile leaks were seen in three donors (3.7% in EDR group Vs RDR 1.9% in P=0.558), none of them required endobiliary interventions. Re-Exploration for intestinal obstruction was required for 3 donors in RDR (0% vs 5.7%; p-0.079). CONCLUSION: EDR by “3x3” rule after LDH is safe and associated with significantly better pain relief. On per treatment analysis, EDR was associated with significantly less hospital stay, pulmonary and overall complications. Clinical Trial Registry: Clinical Trials.gov - NCT04504487.

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Section: Post Operative Parametersmentioning

confidence: 99%

Early drain removal after live liver donor hepatectomy is safe - A randomized control trial

Durairaj

Pamecha

Mohapatra

et al. 2022

Preprint

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“…Third step includes viral markers, tumor markers and cardiopulmonary evaluation. Fourth step includes pre-anaesthetic check-up and legal authorization.After completion of evaluation, preoperative informed written video consent was taken for all donors and recipients [4].…”

Section: Donor Selectionmentioning

confidence: 99%

“…LDH was done as per standard protocol, which was described in detail in our previous studies [1,4]. In brief, operation is started using J incision followed by laparotomy.…”

Section: Donor Operationmentioning

confidence: 99%

“…Central line is removed by postoperative day 1, urinary catheter on day 2, epidural catheter on day 5, and drain is removed as per study protocol. Donors are usually discharged on or after POD 7, once they are pain free and drain was removed with improving LFT values [4].…”

Section: Donor Operationmentioning

confidence: 99%

“…Routinely drain is removed after LDH, once the content is serous and volume is less than 100ml, which is usually by post-operative day (POD) 5 [4]. Several retrospective studies have suggested early drain removal can be safe [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Early drain removal after live liver donor hepatectomy is safe — a randomized controlled pilot study

Durairaj,

Pamecha,

Mohapatra

et al. 2023

Langenbecks Arch Surg

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INTRODUCTION:The aim of current study was to assess safety of early drain removal after live donor hepatectomy (LDH). METHODS: 108 consecutive donors who met the inclusion criteria, were randomized to Early Drain Removal (EDR -post operative day (POD) 3 -if serous and the drain bilirubin level was less than 3 times of serum bilirubin -"3x3" rule) and Routine Drain Removal (RDR -drain output serous and less than 100ml). Primary outcome was to compare the safety. Secondary outcomes was to compare the postoperative morbidity.RESULTS: Pre-operative, intra-operative and postoperative parameters except for timing of drain removal were comparable. EDR was feasible in 46 out of 54 donors (85.14%) and none required re-intervention after EDR. There was signi cantly better pain relief with EDR (p=0.00). Overall complications, pulmonary complications, and hospital stay were comparableon intention-to-treat analysis. However, pulmonary complications (EDR -1.9% Vs RDR -16.3% P= 0.030), overall complications (18.8% Vs 36.3%, P= 0.043) and hospital stay (8 Vs 9, P= 0.014) were more in RDR group on per treatment analysis. Bile leaks were seen in three donors (3.7% in EDR group Vs RDR 1.9% in P=0.558), none of them required endobiliary interventions. Re-Exploration for intestinal obstruction was required for 3 donors in RDR (0% vs 5.7%; p-0.079).CONCLUSION: EDR by "3x3" rule after LDH is safe and associated with signi cantly better pain relief. On per treatment analysis, EDR was associated with signi cantly less hospital stay, pulmonary and overall complications.

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Routine Postoperative Antibiotic Prophylaxis Offers No Benefit after Hepatectomy—A Systematic Review and Meta-Analysis

et al. 2022

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Background: Prophylactic antibiotics are frequently administered after major abdominal surgery including hepatectomies aiming to prevent infective complications. Yet, excessive use of antibiotics increases resistance in bacteria. The aim of this systematic review and meta-analysis is to assess the efficacy of prophylactic antibiotics after hepatectomy (postoperative antibiotic prophylaxis, POA). Method: This systematic review and meta-analysis were completed according to the current PRISMA guidelines. The protocol has been registered prior to data extraction (PROSPERO registration Nr: CRD42021288510). MEDLINE, Web of Science and CENTRAL were searched for clinical reports on POA in hepatectomy restrictions. A random-effects model was used for synthesis. Methodological quality was assessed with RoB2 and ROBINS-I. GRADE was used for the quality of evidence assessment. Results: Nine comparative studies comprising 2987 patients were identified: six randomized controlled trials (RCTs) and three retrospectives. POA did not lead to a reduction in postoperative infective complications or have an effect on liver-specific complications—post-hepatectomy liver failure and biliary leaks. POA over four or more days was associated with increased rates of deep surgical site infections compared to short-term administration for up to two days (OR 1.54; 95% CI [1.17;2.03]; p = 0.03). Routine POA led to significantly higher MRSA incidence as a pathogen (p = 0.0073). Overall, the risk of bias in the studies was low and the quality of evidence moderate. Conclusion: Routine POA cannot be recommended after hepatectomy since it does not reduce postoperative infection or liver-specific complications but contributes to resistance in bacteria. Studies into individualized risk-adapted antibiotic prophylaxis strategies are needed to further optimize perioperative treatment in liver surgery.

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Randomized control trial on perioperative antibiotic prophylaxis in live liver donors: Are three doses enough?

Cited by 3 publications

References 31 publications

Early drain removal after live liver donor hepatectomy is safe - A randomized control trial

Early drain removal after live liver donor hepatectomy is safe - A randomized control trial

Early drain removal after live liver donor hepatectomy is safe — a randomized controlled pilot study

Routine Postoperative Antibiotic Prophylaxis Offers No Benefit after Hepatectomy—A Systematic Review and Meta-Analysis

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