Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

Abstract

The aim of this study was to explore the impact of 3% hypertonic saline (HS) intragastric administration for patients who underwent upper gastrointestinal surgery.During the postoperative period, 3% HS has been suggested as a means to improve the intestinal edema and reduce gastrointestinal complications.The medical records of 111 patients with HS intragastric administration following upper gastrointestinal surgery and 268 patients, served as control, were reviewed retrospectively. Propensity score matching was performed to adjust for selected baseline variables. Clinical outcomes, including early gastrointestinal function recovery, postoperative complications, and length of hospital stay, were compared according to the HS intragastric administration or not.HS intragastric administration was associated with prompt postoperative gastrointestinal function recovery, including first flatus (risk ratio [RR], 1.32; 95% confidence interval [CI], 0.89–1.65; P = 0.048) and feeding within 3 postoperative days (RR (95% CI), 0.57 (0.49–0.77); P = 0.036). Early ileus occurred in 25 of 108 patients with HS treatment versus 36 of 108 patients without HS treatment (RR (95% CI), 1.43 (0.63–2.15); P = 0.065). The patients with HS experienced a lower overall postoperative complication (odds ratio [OD] 0.57; 95% CI, 0.33–1.09; P = 0.063), including trend toward a decrease for infectious complications (15[13.9] vs 23[21.3]; P = 0.11; OD, 0.59; 95% CI, 0.29–1.22). There was a decreased incidence of anastomotic leakage (1[0.9] vs 7[6.5]; P = 0.033) and postoperative ileuas (5[4.6%] vs 11[10.2%]; P = 0.096) in the HS administration patients.Our study demonstrated beneficial postoperative clinical effects of HS intragastric administration in patients who had undergone upper gastrointestinal surgery, such as prompt postoperative gastrointestinal function recovery and reduced overall postoperative complications, which may be attributed to a reduced intestinal edema.

Hypertonic saline for goal-directed therapy guided by Capstesia in gastrointestinal surgery: a randomized controlled study

“…However, it is to be noted that the decision of patient's discharge in our institute is difficult to control and is governed by many factors such as surgeon preference and the distance of patient's residence. Analogous to these results are those reported by Hong et al [9], where they found that the mean length of hospital stays in patients with HS treatment were similar to patients without HS treatment. The rate of postoperative complications was higher in the LR group, and this could be attributed to the larger volumes infused in this group.…”

“…Hong et al . [ 9 ] found that intra-gastric administration of 3% HS for patients who underwent upper GI surgery improved the intestinal edema and reduced the incidence of anastomotic leakage and post-operative ileus.…”

“…These results failed to reach statistical significance, although they were approaching it (P = 0.052). Hong et al [9] found that intragastric administration of HS was associated with prompt postoperative gastrointestinal function recovery, including first flatus (P = 0.048) and feeding within three postoperative days (P = 0.036). Radhakrishnan et al [14] found that HS can improve intestinal transit and preserve tissue stiffness and residual stress in the setting of established intestinal edema.…”

“…This positive correlation means that increasing the amount of infused fluids consequently increases the POSSUM score, and accordingly, the risk prediction of morbidity and mortality increases. Hong et al [9] found that intra-gastric administra-tion of 3% HS for patients who underwent upper GI surgery improved the intestinal edema and reduced the incidence of anastomotic leakage and post operative ileus. Although the CO results in our study were comparable between groups, the CI results showed statistical significance at certain time points; this difference could be explained by the divergence in body surface area values between patients, as CI is normally calculated by dividing the CO by the body surface area values.…”

“…Hypertonic saline (HS) offers many beneficial hemodynamic properties, such as rapid expansion of intravascular volume, reduction of endothelial and tissue edema, and increased myocardial contractility [ 7 , 8 ]. Intragastric HS administration in patients who have undergone upper GI surgery proved prompt postoperative GI function recovery and reduced overall postoperative complications [ 9 ]. There is still a need for less expensive monitoring devices to guide GDT during anesthesia.…”