The impact of intra- and postoperative fluid balance in pancreatic surgery - A retrospective cohort study

Patricia Marie Doll, Louisa Bolm, Ruediger Braun, Kim C. Honselmann, Steffen Deichmann, Birte Kulemann, Iurii Kuchyn, Sergii Zemskov, Dirk Bausch, Tobias Keck*, Ulrich Friedrich Wellner, Hryhoriy Lapshyn

*Korrespondierende/r Autor/-in für diese Arbeit

Abstract

Background/objectives: The aim of this study was to evaluate the impact of perioperative fluid administration in pancreatic surgery. Methods: Patients who underwent pancreatic resections were identified from our institution's prospectively maintained database. Fluid balances were recorded intraoperatively and at 24hr postoperatively. Patients were stratified into tertiles of fluid administration (low, medium, high). Adjusted multivariable analysis was performed and outcome measures were postoperative complications. Results: A total of 211 patients were included from 2012 to 2017. Complication rates were POPF(B/C) 19.4%, DGE(B/C) 14.7%, PPH(C) 10.0% and CDC ≥ IIIb 26.1%. In multivariable analysis, high perioperative fluid balance was an independent risk factor associated with POPF (OR = 10.5, 95%CI 2.7–40.7, p = .001), CDC (OR = 2.5, 95%CI 1.2–5.3, p < .002), DGE (OR = 2.3, 95%CI 1.0–5.2, p = .017), PPH (OR = 6.7 95%CI 2.2–20.0, p = .038) and reoperation (OR = 3.1, 95%CI 1.6–6.2, p = .006). In multivariable analysis with intraoperative and postoperative fluid balances as separate predictors, intraoperative (OR = 2,5, 95%CI 1.2–5.5, p = .04) and postoperative fluid balance (OR = 2.5, 95%CI 1.2–5.5, p = .02) were predictors of POPF. Postoperative fluid balance was the only predictor for mortality (OR = 4.5, 95%CI 1.0–18.9, p = .041) and predictor for CDC (OR = 2.0, 95%CI 1.0–4.0, p = .043) and OHS days (OR = 6.9, 95%CI 0.03–13.7, p = .038). Conclusions: High postoperative fluid balance in particular is associated with postoperative morbidity. Maintaining a fluid-restrictive strategy postoperatively should be recommended for patients undergoing pancreatic surgery.

OriginalspracheEnglisch
ZeitschriftPancreatology
Jahrgang23
Ausgabenummer6
Seiten (von - bis)689-696
Seitenumfang8
ISSN1424-3903
DOIs
PublikationsstatusVeröffentlicht - 09.2023

Strategische Forschungsbereiche und Zentren

  • Profilbereich: Lübeck Integrated Oncology Network (LION)
  • Zentren: Universitäres Cancer Center Schleswig-Holstein (UCCSH)

DFG-Fachsystematik

  • 205-25 Allgemein- und Viszeralchirurgie

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