Effects of 24-hour postoperative intravenous fluid on postoperative outcomes after lobectomy: a retrospective observational study

Abstract

Background: Postoperative fluid management plays a key role in providing adequate tissue perfusion, stabilizing hemodynamics, and reducing morbidities related to hemodynamics. This study evaluated the dose-response relationship between postoperative 24-hour intravenous fluid volume and postoperative outcomes in patients with non-small cell lung cancer (NSCLC) undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. Methods: A retrospective analysis of adult patients with NSCLC undergoing VATS lobectomy betweenMay 2016 and April 2017 was performed. The primary exposure variable was total intravenous crystalloid infusion in the 24-hour postoperative period. The observation outcomes were postoperative pulmonary complications, acute kidney injury (AKI), in-hospital mortality, readmission within 30 days, prolonged hospital stay, postoperative length of stay, and total hospital care costs. Univariate and multivariate analyses were performed.Results: Of the 563 patients, 136 (24.2%) with pulmonary complications were observed. Binary logistics regression showed that, relative to the group with moderate postoperative 24-hour crystalloid infusion, the risk for postoperative pulmonary complications was significantly increased in the restrictive [odds ratio (OR) 1.815, 95% CI: 1.083-3.043; P=0.024] and liberal (OR 2.692, 95% CI: 1.684-4.305; P<0.001) groups. Conclusions:In patients with NSCLC undergoing VATS lobectomy, both restrictive and liberal 24-hour postoperative crystalloid infusions were related to adverse effects on postoperative outcomes and the optimal volume of 24-hour postoperative intravenous crystalloid infusion was 1,080-<1,410 mL.

Modern fluid management in thoracic surgery

“…Little has been published about postoperative IV fluid infusions after thoracic surgery. One study showed that infusions of more than 1410 ml/24 h were associated with PPCs, as were infusion rates of less than 1080 ml/24 h [41]. However, it is difficult to know how to interpret these results as the intraoperative fluid infusion rates were high (around 12 ml/kg/hour) and oral fluids and diet were not resumed until 6–8 h after surgery.…”