The Effect of Intraoperative Fluid Volume Administration on Pancreatic Fistulas after Pancreaticoduodenectomy

Wang, Sizhen; Wang, Xinbo; Dai, Hongshan; Han, Jun; Li, Ning; Li, Jieshou

doi:10.3109/08941939.2013.839766

Cited by 40 publications

(42 citation statements)

References 23 publications

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“…That is correct and a limitation of this study, but we decided to use this parameter since it seems to allow better comparability, especially with respect to the postoperative phase in which fluids are usually administered only if certain physiological parameters (urine output, blood pressure) are not maintained. The amounts of fluids administered in our study are comparable to the available studies on fluid management in PD [18], [19], [20], [21], [22], [23], [24], [25]. Despite its limitations, this large cohort of 553 patients is very homogeneous with respect to operation technique and SICU management.…”

Section: Discussionsupporting

confidence: 59%

“…This is a large patient cohort; other studies from the field include 98–577 patients [18], [19], [20], [21], [22], [23], [25].…”

Section: Discussionmentioning

confidence: 99%

“…However, most of these trials were conducted with patients undergoing colorectal surgery [14], [15] and abdominal aortic repair [30], [31] thus, it remains unclear whether their findings apply to PD patients. The studies on fluid management in patients undergoing PD are limited, and show contradictory results with respect to intraoperative fluid therapy and postoperative outcome [18], [19], [20], [21], [22], [23], [24], [25]. Additionally, studies on post operative fluid management after PD are lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, studies on post operative fluid management after PD are lacking. Most studies focus on IOF administration [13], [18], [19], [20], [24], [25] and only few studies describe [12], [21], [22], [23], [30] and partly analyze [21] the postoperative phase: only one group found that higher fluid balance at 48 and 72 h postoperatively was an independent predictor of morbidity and length of stay on multivariate analysis [21].…”

Section: Discussionmentioning

confidence: 99%

“…The results are contradictory; some suggest that excessive use of intraoperative fluid leads to more postoperative morbidity and mortality [18], [19], [20], [21], [22], [23], while others do not find these associations [13], [24], [25].…”

Section: Introductionmentioning

confidence: 96%

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Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: A single center retrospective cohort study

Kulemann

Fritz

Glatz

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundPerioperative mortality after pancreaticoduodenectomy has decreased significantly in high-volume centers, but morbidity remains high. Restrictive perioperative fluid management may contribute to reduced complication rates after various surgical procedures. The aim of this study was to determine whether there is a correlation between the amount of fluid administered and postoperative complications. We hypothesized that higher amounts of intra- and total fluid is associated with greater postoperative morbidity.Materials and methodsWe retrospectively examined data of 553 patients who underwent pancreaticoduodenectomy at University of Freiburg Medical Center between 2001 and 2013. Data on intra - and postoperative fluid administration (until postoperative day 5) were obtained from anesthesiological and surgical records. Data on complications were retrieved from our institutional pancreatic database.ResultsThe median values for intra- and total fluid administered were 6000 ml (range 400–15,000 ml) and 13,600 ml (range 5000–57,700 ml), respectively. The overall in-hospital mortality was 1.9% (no correlation with fluid administration). Patients who received more than 6000 ml intraoperative fluid had more wound infections (P = 0.049), intra-abdominal abscesses (P = 0.020) and postoperative interventions (P = 0.007). In patients who received more than 14000 ml fluid until postoperative day 5 all evaluated types of postoperative complications (infectious, fistula, delayed gastric emptying, bleeding) and re-interventions occurred significantly more frequently than in patients who received less than 14,000 ml (P < 0.05–0.001).ConclusionsHigher amounts of fluids may contribute to postoperative complications. More studies are needed to adequately assess the use of intra/postop fluid therapy.

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Section: Discussionsupporting

confidence: 59%

“…This is a large patient cohort; other studies from the field include 98–577 patients [18], [19], [20], [21], [22], [23], [25].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 3 more Smart Citations

Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: A single center retrospective cohort study

Kulemann

Fritz

Glatz

et al. 2017

Annals of Medicine &Amp; Surgery

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Surgical drain placement in distal pancreatectomy is associated with an increased incidence of postoperative pancreatic fistula and higher readmission rates

Mangieri

Kuncewitch

Fowler

et al. 2020

Journal of Surgical Oncology

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BackgroundPostoperative pancreatic fistula (POPF) can result in significant morbidity after distal pancreatectomy (DP). It is common practice to place prophylactic surgical drains during DP to monitor and minimize POPF complications; however, their use is controversial.ObjectiveThe aim of this study is to determine if drainage helps to prevent adverse outcomes and decrease the need for additional interventions after DP.MethodsAll patients who underwent DP without vascular resection were identified in the 2014 Targeted Pancreatectomy American College of Surgeons National Surgery Quality Improvement Program Participant Use File. Patients undergoing emergency procedures, American Society of Anesthesiology (ASA) 5, or diagnosed with preoperative sepsis were excluded. Univariate and multiple variable analyses were performed to evaluate postoperative outcomes based on use of surgical drain.ResultsA total of 1158 patients (age median: 62; interquartile range: 16; female 58.6%) underwent elective DP with 85.1% (n = 985) having drain placed at time of operation. Laparoscopic technique was used in the majority of patients (54.1%, n = 619). POPF occurred in 201 patients (17.5%). Additional percutaneous drain was required in 106 patients (9.2%). POPF was higher in surgical drain group, 19.4% vs 6.9% (P < .001). Need for percutaneous drain was similar between drain and no drain groups, 9.3% vs 8.1% (P = .600). Postoperative sepsis, shock, major complication, reoperation, and 30‐day mortality was similar between drain and no drain groups (all P > .05). However, readmission was higher in the surgical drain group, 17.8% vs 10.4% (odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.1‐3.1; P = .018). After adjusting for age, ASA, and operative time, readmission remained higher in the surgical drain group (OR: 1.9; 95% CI: 1.1‐3.2; P = .016).ConclusionThe use of surgical drainage during DP was associated with increased incidence of readmission and POPF. Drainage showed no effect on outcomes of postoperative sepsis, shock, major complications, reoperation, and 30‐day mortality. Based on these results, routine prophylactic drainage should be reconsidered for patients undergoing DP.

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Post-Operative Pancreatic Fistula After Pancreatic Surgery

Søreide

Sallinen

Rystedt

et al. 2021

Textbook of Pancreatic Cancer

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The Effect of Intraoperative Fluid Volume Administration on Pancreatic Fistulas after Pancreaticoduodenectomy

Abstract: High intraoperative fluid volume administration is associated with an increased incidence of pancreatic fistulas after pancreaticoduodenectomy.

Cited by 40 publications

References 23 publications

Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: A single center retrospective cohort study

Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: A single center retrospective cohort study

Surgical drain placement in distal pancreatectomy is associated with an increased incidence of postoperative pancreatic fistula and higher readmission rates

Post-Operative Pancreatic Fistula After Pancreatic Surgery

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