Intraoperative Fluid Administration and Surgical Outcomes Following Pancreaticoduodenectomy: External Validation at a Tertiary Referral Center
M. Sandini
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorC. Fernández-del Castillo
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorC. R. Ferrone
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorK. J. Ruscic
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorM. Eikermann
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorA. L. Warshaw
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorK. D. Lillemoe
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorCorresponding Author
M. Qadan
- [email protected]
- 617-643-5143
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Tel.: 617-643-5143, [email protected]Search for more papers by this authorM. Sandini
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorC. Fernández-del Castillo
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorC. R. Ferrone
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorK. J. Ruscic
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorM. Eikermann
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorA. L. Warshaw
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorK. D. Lillemoe
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Search for more papers by this authorCorresponding Author
M. Qadan
- [email protected]
- 617-643-5143
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-3117 Boston, MA, USA
Tel.: 617-643-5143, [email protected]Search for more papers by this authorThe paper was presented during the Digestive Disease Week® (DDW) at the Walter E. Washington Convention Center in Washington, D.C., June 2–5, 2018.
Electronic supplementary material: The online version of this article (https://doi.org/10.1007/s00268-018-4842-0) contains supplementary material, which is available to authorized users.
Abstract
Background
While intraoperative fluid overload is associated with higher complication rates following surgery, data for pancreaticoduodenectomy are scarce and heterogeneous. We evaluated multiple prior definitions of restrictive and liberal fluid regimens and analyzed whether these affected surgical outcomes at our tertiary referral center.
Methods
Studies evaluating different intraoperative fluid regimens on outcomes after pancreatic resections were retrieved. After application of all prior definitions of restrictive and liberal fluid regimens to our patient cohort, relative risks of each outcome were calculated using all reported infusion regimens.
Results
Five hundred and seven pancreaticoduodenectomies were included. Nine different fluid regimens were evaluated. Two regimens utilized absolute volume cutoffs, and the remaining evaluated various infusion rates, ranging from 5 to 15 mL/kg/h. Total volume administration of >5000 mL and >6000 mL was associated with increased complications (RR 1.25 and RR 1.17, respectively) and >6000 mL with increased sepsis (RR 2.14). Conversely, a rate of <5 mL/kg/h was associated with increased risk of postoperative pancreatic fistula (POPF, RR 3.16) and sepsis (RR 3.20), <6.8 mL/kg/h with increased major morbidity (RR 1.64) and sepsis (RR 2.27), and <8.2 mL/kg/h with increased POPF (RR 2.16). No effects were observed on pulmonary complications, surgical site infections, length of stay, or mortality.
Conclusions
In an uncontrolled setting with no standard intraoperative or postoperative care map, the volume of intraoperative fluid administration appears to have limited impact on early postoperative outcomes following pancreaticoduodenectomy, with adverse outcomes only seen at extreme values.
Supporting Information
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