Intraoperative fluid administration is associated with perioperative outcomes in pancreaticoduodenectomy: A single center retrospective analysis

Abstract

Background Recent studies on perioperative fluid administration in patients undergoing major abdominal surgery have suggested that increased fluid loads are associated with worse perioperative outcomes. However, results of retrospective analyses of the relationship between intraoperative fluid (IOF) administration and perioperative outcomes in patients undergoing pancreaticoduodenectomy (PD) are conflicted. We sought to investigate this relationship in patients undergoing PD at our academic center. Methods A retrospective analysis of 124 patients undergoing PD from 2007 to 2012 was performed. IOF administration rate (ml/kg/hr) was correlated with perioperative outcomes. Outcomes were also stratified by preoperative serum albumin level. Results Regression analyses were performed comparing independent perioperative variables, including IOF rate, to four outcomes variables: length of stay, severity of complications, number of complications per patient, and 30-day mortality. Both univariate and multivariate regression analyses showed IOF rate correlated with one or more perioperative outcomes. Patients with an albumin ≤3.0 g/dl who received more than the median IOF rate experienced more severe complications, while patients with an albumin >3.0 g/dl did not. Conclusion Increased IOF administration is associated with worse perioperative outcomes in patients undergoing PD. Patients with low preoperative serum albumin levels (≤3.0 g/dl) may be a group particularly sensitive to volume overload.

Fluid administration and morbidity in transhiatal esophagectomy

“…We have previously shown in patients undergoing pancreaticoduodenectomy that malnourished patients are a group in that may be particularly sensitive to the harmful effects of volume overload [10]. To investigate the relationship of malnutrition and IOF rate to morbidity in THE patients, we stratified the patients by the median preoperative serum albumin (3.7 g/dL) and compared IOF rates to outcomes.…”

“…Although the median IOF rate in this subset of patients was greater than the median IOF rate of the total cohort, this difference was not statistically significant. These patients experienced more severe postoperative complications by 90 days [10]. As in pancreatic cancer, esophageal carcinoma is a disease in which patients often present malnourished.…”

“…Intraoperative fluid (IOF) administration was determined by combining administered crystalloid, colloid, and blood products based on anesthesia records and analyzed as a fluid rate (mL/kg/hr), as we have previously demonstrated [10]. We used intraoperative fluid rates for analyses rather than total fluid volumes because it allowed us to control for differences in patient weight and operative time, which are two variables that can impact total fluid volumes.…”

“…Hypoalbuminemia leads to greater intravascular volume loss during periods of fluid administration and can thus exacerbate the negative consequences of volume overload. We demonstrated this in patients undergoing pancreaticoduodenectomy at our institution, in which hypoalbuminemic patients who received a greater intraoperative fluid rate experienced more severe complications [10]. …”

Pancreatic Resection Results in a Statewide Surgical Collaborative

“…34–37 Our data did not provide us with the ability to understand individual case decision making, nor could we control for operations performed. Consequently, we could not provide explanations for such things as why extended lymphadenectomy increased in high-volume hospitals or why rates of additional organ resections, including liver resections, were higher than might be expected on the average in pancreatic resections.…”