Perioperative fluids and complications after pancreatoduodenectomy within an enhanced recovery pathway

Abstract

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.

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study

“…The secondary outcome of interest, a clinically relevant postoperative pancreatic fistula (Grade B or C), was observed in 11.9% of the cohort, consistent with other reports. [ 6 , 9 , 10 , 15 , 37 ]. In those studies, increased intraoperative [ 9 ] or post-operative [ 15 ] fluid balance was associated with a CR-POPF.…”

“…In those studies, increased intraoperative [ 9 ] or post-operative [ 15 ] fluid balance was associated with a CR-POPF. Others showed no multivariate association between volume status and Grade B or C POPF [ 6 , 11 , 12 , 37 ]. Our multivariate observations align with the findings that indicate no association between volume status and Grade B or C POPF.…”

A Single-Center Retrospective Study of Selected Clinical Parameters and Intraoperative Fluid Management of Patients Undergoing Pancreatoduodenectomy

“…According to Gottin et al [ 45 ], significantly fewer postoperative complications (eg, postoperative fistula, abdominal collection, and hemorrhage) were found in the restrictive fluid therapy group (≤4 ml/kg/h) than in patients who had received liberal fluid therapy (≥12 ml/kg/h). Gilgien et al [ 46 ] also concluded that patients who received ≥4400 ml intravenous fluids during the first 24 h after surgery had more complications, especially pulmonary complications. Liberal fluid therapy may also lead to an increase in postoperative pancreatic fistula (POFF) formation [ 47 ].…”

Abdominal Organ Transplantation: Noteworthy Literature in 2021

“…For pain control, pre-induction single dose of IV dexmedetomidine 11 paracetamol 12 truncal analgesic blocks, specifically transversus abdominus plane and quadratus lumborum blocks, 13 are advocated. They recommend against excess fluid administration, 14 although there is no evidence to support the use of restricted fluid regimens such as goal-directed fluid therapy. 10 As with the general surgical population, avoiding nasogastric tube placement in pancreatic transplant recipients resulted in a decreased hospital length of stay without resulting in other complications.…”