The HYSLAR Trial

Lavu, Harish; Sell, Naomi M.; Carter, Timothy I.; Winter, Jordan M.; Maguire, David; Gratch, David M.; Berman, Richard A.; Feil, Marian G.; Grunwald, Zvi; Leiby, Benjamin E.; Pequignot, Edward; Rosato, Ernest L.; Yeo, Charles J.

doi:10.1097/sla.0000000000000872

Cited by 61 publications

(23 citation statements)

References 35 publications

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“…Established practices of liberal perioperative fluid administration are being challenged in a variety of gastrointestinal operations, as prospective randomized trials comparing restrictive versus liberal fluid practices have demonstrated improved perioperative outcomes [6–8,11]. While this evidence has been mounting, there is still controversy as to what type of abdominal operations this may apply to, as well as what types of fluid administrative practices constitute “restrictive”.…”

Section: Discussionmentioning

confidence: 99%

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Fluid administration and morbidity in transhiatal esophagectomy

Eng

Arlow

Moore

et al. 2016

Journal of Surgical Research

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Background Esophagectomy is associated with significant morbidity. Optimizing perioperative fluid administration is one potential strategy to mitigate morbidity. We sought to investigate the relationship of intraoperative fluid (IOF) administration to outcomes in patients undergoing transhiatal esophagectomy with particular attention to malnourished patients, who may be more susceptible to the effects of fluid overload. Material and methods Patients who underwent transhiatal esophagectomy from 2000–2013 were identified from a retrospective database. IOF rates (mL/kg/hr) were determined and their relationship to outcomes compared. To examine the impact of malnutrition, we stratified patients based on median preoperative serum albumin and compared outcomes. Results and discussion 211 patients comprised the cohort. 74% of patients underwent esophagectomy for esophageal adenocarcinoma. Linear regression analyses were performed comparing independent perioperative variables to four outcomes variables: length of stay, complications per patient, major complications, and Clavien-Dindo classification. IOF rate was significantly associated with three of four outcomes on univariate analysis. Significantly more patients with a preoperative albumin level ≤3.7 g/dL who received more than the median IOF rate experienced more severe complications. Conclusions Increased intraoperative fluid administration is associated with perioperative morbidity in patients undergoing transhiatal esophagectomy. Patients with lower preoperative albumin levels may be particularly sensitive to the effects of volume overload.

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Section: Discussionmentioning

confidence: 99%

“…The majority of prospective randomized trials investigating this have been in the setting of elective colorectal surgery, although recently studies in pancreatic surgery are gaining [6–8,11]. There have been none in esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Fluid administration and morbidity in transhiatal esophagectomy

Eng

Arlow

Moore

et al. 2016

Journal of Surgical Research

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“…Previous authors have found mixed results; however, few trials have focused purely on pancreatic resection. 20 Our previous retrospective analysis of 1030 patients 25 did not show a difference in the Grade 3 complication rate which prompted the current trial.…”

Section: Discussionmentioning

confidence: 80%

“…This was also addressed more recently in a fluid trial using hypertonic saline in the restricted arm. 20 However, two retrospective reviews of fluid management in patients undergoing pancreatectomy did not demonstrate a clinically significant association between postoperative morbidity and intraoperative fluid administration. 25,26 In an effort to definitively address this question we conducted a prospective randomized trial of Liberal (LIB) versus Restricted (RES) fluid administration for patients undergoing elective pancreatectomy.…”

Section: Introductionmentioning

confidence: 99%

“…3–13 In the 2000s, a number of randomized trials demonstrated a positive association between liberal fluid management and postoperative complications in colorectal surgery and other intraabdominal operations. 5,6,14–20 However, not all studies supported the restricted approach and some found fluid restriction to be harmful. 21–23 The majority of these studies did not include a significant number of pancreatic resections.…”

Section: Introductionmentioning

confidence: 99%

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Prospective Randomized Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy

et al. 2016

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Clinical trial registration: NCT01058746 Objective To examine, by a prospective randomized controlled trial, the influence of Liberal (LIB) versus Restricted (RES) perioperative fluid administration on morbidity following pancreatectomy. Summary Background Data Randomized controlled trials in patients undergoing major intra-abdominal surgery have challenged the historical use of liberal fluid administration, suggesting a more restricted regimen may be associated with fewer postoperative complications. Methods Patients scheduled to undergo pancreatic resection were consented for randomization to a LIB (n=164) or RES (n=166) perioperative fluid regimen. Sample size was designed with 80% power to decrease Grade 3 complications from 35% to 21%. Results Between July 2009 and July 2015, we randomized 330 patients undergoing pancreaticoduodenectomy (PD, n=218), central (n=16) or distal pancreatectomy (DP, n=96). Patients were equally distributed for all demographic and intraoperative characteristics. Intraoperatively, LIB patients received crystalloid 12ml/kg/hr and RES patients 6ml/kg/hr. Cumulative crystalloid given (median, range, ml) days 0–3 was LIB: 12252 (6600–21365), RES 7808 (2700–16274) p<0.0001. Sixty day mortality was 2/330 (0.6%). Median operative time for PD was 227 minutes (105–462) and DP 150 (44–323). Grade 3 complications occurred in 20% of LIB and 27% of RES patients (p=0.6). Median length of stay was 7 days and 5 days for PD and DP, respectively, in both arms. Conclusions In a high volume institution, major perioperative complications from pancreatic resection were not significantly influenced by fluid regimens that differed approximately 1.6 fold.

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