Impact of fluid resuscitation on major adverse events following pancreaticoduodenectomy

Behman, Ramy; Hanna, Sherif S.; Coburn, Natalie; Law, Calvin; Cyr, David P.; Truong, Jessica; Lam-McCulloch, Jenny; McHardy, Paul; Sawyer, Jason; Idestrup, Chris; Karanicolas, Paul J.

doi:10.1016/j.amjsurg.2015.04.020

Cited by 29 publications

(41 citation statements)

References 24 publications

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“…Inappropriate perioperative fluid intervention and likely tissue hypoperfusion and/or oedema are strongly associated with the development of postoperative complications for patients undergoing major abdominal surgery including PD [ 4 , 6 – 8 ]. Enhanced Recovery After Surgery programmes (ERAS) for patients undergoing PD have advocated a more judicious use of intravenous (IV) fluid administration [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Enhanced Recovery After Surgery programmes (ERAS) for patients undergoing PD have advocated a more judicious use of intravenous (IV) fluid administration [ 9 , 10 ]. ERAS programs for PD have been widely adopted impacting positively on length of stay, while not increasing rates of peri-operative morbidity, mortality or readmission [ 11 ]. While ERAS has been shown to be beneficial to patient outcomes when compared to usual care in patients receiving PD, no trials have examined the additional impact of an intraoperative fluid optimisation algorithm.…”

Section: Introductionmentioning

confidence: 99%

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Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial

et al. 2017

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We aimed to evaluate perioperative outcomes in patients undergoing pancreaticoduodenectomy with or without a cardiac output goal directed therapy (GDT) algorithm. We conducted a multicentre randomised controlled trial in four high volume hepatobiliary-pancreatic surgery centres. We evaluated whether the additional impact of a intraoperative fluid optimisation algorithm would influence the amount of fluid delivered, reduce fluid related complications, and improve length of hospital stay. Fifty-two consecutive adult patients were recruited. The median (IQR) duration of surgery was 8.6 hours (7.1:9.6) in the GDT group vs. 7.8 hours (6.8:9.0) in the usual care group (p = 0.2). Intraoperative fluid balance was 1005mL (475:1873) in the GDT group vs. 3300mL (2474:3874) in the usual care group (p<0.0001). Total volume of fluid administered intraoperatively was also lower in the GDT group: 2050mL (1313:2700) vs. 4088mL (3400:4525), p<0.0001 and vasoactive medications were used more frequently. There were no significant differences in proportions of patients experiencing overall complications (p = 0.179); however, fewer complications occurred in the GDT group: 44 vs. 92 (Incidence Rate Ratio: 0.41; 95%CI 0.24 to 0.69, p = 0.001). Median (IQR) length of hospital stay was 9.5 days (IQR: 7.0, 14.3) in the GDT vs. 12.5 days in the usual care group (IQR: 9.0, 22.3) for an Incidence Rate Ratio 0.64 (95% CI 0.48 to 0.85, p = 0.002). In conclusion, using a surgery-specific, patient-specific goal directed restrictive fluid therapy algorithm in this cohort of patients, can justify using enough fluid without causing oedema, yet as little fluid as possible without causing hypovolaemia i.e. “precision” fluid therapy. Our findings support the use of a perioperative haemodynamic optimization plan that prioritizes preservation of cardiac output and organ perfusion pressure by judicious use of fluid therapy, rational use of vasoactive drugs and timely application of inotropic drugs. They also suggest the need for further larger studies to confirm its findings.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial

et al. 2017

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“…Previous studies assessing fluid therapy and outcome in PD perfectly reflects this situation. A fair amount of published studies including PD, predominantly retrospective cohort, described an increased rate of postoperative complications with increased fluids [9][10][11][12][13] . However, most randomized controlled studies [14][15][16] failed to show any significant difference in postoperative outcome when comparing liberal to restrictive fluid therapy.…”

Section: Discussionmentioning

confidence: 99%

Perioperative fluids and complications after pancreatoduodenectomy within an enhanced recovery pathway

Gilgien

Halkic

Demartines

et al. 2020

Sci Rep

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Optimized fluid management is a key component of enhanced recovery (ERAS) pathways. Implementation is challenging for pancreatoduodenectomy (PD) and clear guidance is missing in the respective protocol. The aim of this retrospective study was to evaluate the influence of perioperative intravenous (IV) fluid administration on postoperative complications. 164 consecutive patients undergoing PD within ERAS between October 2012 and June 2017 were included. Perioperative IV fluid and morbidity (Clavien classification and comprehensive complication index (CCI)) were assessed. A threshold of more than 4400 ml IV fluid during the first 24 h could be identified to predict occurrence of complications (area under ROC curve 0.71), with a positive and negative predictive value of 93 and 23% respectively. More than 4400 ml intravenous fluids during the first 24 h was an independent predictor of overall postoperative complications (adjusted odds ratio 4.40, 95% CI 1.47–13.19; p value = 0.008). Patients receiving ≥ 4400 ml were associated with increased overall complications (94 vs 77%; p value < 0.001), especially pulmonary complications (31 vs 16%; p value = 0.037), as well as a higher median CCI (33.7 vs 26.2; p value 0.041). This threshold of 4400 ml intravenous fluid might be a useful indicator for the management following pancreatoduodenectomy.

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“…Nevertheless, maintaining adequate intravascular fluid is crucial for normal organ perfusion. Inappropriate intravascular fluid intervention is strongly associated with postoperative complications after major abdominal surgery [24][25][26][27][28][29][30] . However, the safety of fluid in the perioperative period of abdominal surgery remains unclear [31][32][33][34] .…”

Section: Introductionmentioning

confidence: 99%

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

Cai

Tang

et al. 2019

Preprint

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Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology: We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Among the 472 articles selected from the databases, based on abstract reading, 272 articles were excluded according to the criteria in Figure 1. After reading the complete text, among the 78 remaining articles, excluded were 15 articles with no relevant data about the outcome of restrictive fluid therapy for major abdominal surgery, 54 that were not RCTs, 2 that were meta-analyses, and 7 that were from the same trial. Finally, 11 RCTs published between 2000 and 2018 that compared restrictive fluid therapy with liberal fluid therapy were included. Two studies by the same team were taken as one trial and shared the same study number because some data from the two studies were complementary.. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: the current meta-analysis assessed the effects of restrictive fluid therapy in a meticulous way. Though the large proportional reduction in risk of complications as indicated in the previous literature was not confirmed, moderate but clinically notable reduction in complications is still worth our attention. The application of restrictive fluid therapy requires communication and cooperation between medical workers and patients. RCTs on restrictive fluid therapy with long-term follow-up are needed. Hospital costs and quality of life after surgery should also be taken into account. Furthermore, the benefits of restrictive fluid therapy in elderly patients and patients who have undergone other surgeries might be the focus of future research..

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Impact of fluid resuscitation on major adverse events following pancreaticoduodenectomy

Cited by 29 publications

References 24 publications

Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial

Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial

Perioperative fluids and complications after pancreatoduodenectomy within an enhanced recovery pathway

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

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