Impact of postoperative intravenous fluid administration on complications following elective hepato-pancreato-biliary surgery
Daniel Martin a , b , Panagis M. Lykoudis a , c , ∗, Gabriel Jones d , David Highton e , Alan Shaw f , Sarah James b , Qiang Wei g , Giuseppe Fusai a , c
a Division of Surgery & Interventional Science, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK b Royal Free Perioperative Research Group, Royal Free Hospital, Pond st, London, NW3 2QG, UK c Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, Royal Free Hospital, Pond st, London, NW3 2QG, UK d King’s College Hospital, Denmark Hill, London SE5 9RS, UK e Neurocritical Care Unit, the National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK f London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK g Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China
∗ Corresponding author at: Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, Royal Free Hospital, Pond st, London, NW3 2QG, UK.
E-mail address: p.lykoudis@ucl.ac.uk (P.M. Lykoudis).
The impact of perioperative intravenous fluid administration on surgical outcomes has been documented in literature, but not specifically studied in the context of hepato-pancreato-biliary (HPB) surgery. This study aimed to investigate the impact of postoperative intravenous fluid administration on intensive care unit (ICU), in this subgroup of patients.
METHODS:
A single-center retrospective cohort of 241 HPB patients was assessed, focusing on intravenous fluid administration in ICU, during the first 24 h. Intravenous fluid variables were compared to hospital stay and postoperative complications. Data were assessed using Spearman's correlation test for bivariate correlations and logistic regression for multivariate analysis.
RESULTS:
The median volume of intravenous fluid administered in the first 24 h postoperatively was 4380?mL, of which 2200?mL was crystalloid, 1500?mL colloid and 680?mL "other" fluid. Patients with one or more complications had a higher median total intravenous fluid input (4790?vs. 4300?mL), higher colloid volume (2000?vs. 1500?mL), lower urine output (1595?vs. 1900?mL) and greater overall fluid balance (+3040?vs.+2553?mL) than those without complications. There were correlations between total intravenous fluid volume administered (r?=?0.278, P?<?0.001), intravenous colloid input (r?=?0.278, P?<?0.001), urine output (r?=?-0.295, P?<?0.001), positive fluid balance (r?=?0.344, P?<?0.001) and length of hospital stay. Logistic regression model was constructed to predict the occurrence of one or more complications; total intravenous fluid volume and overall fluid balance were both independent significant predictors (OR?=?2.463, P?=?0.007; OR?=?1.001, P?=?0.011; respectively).
CONCLUSIONS:
Administration of high volumes of intravenous fluids in the first 24 hours post-HPB surgery, along with higher positive fluid balance is associated with a higher rate of complications and longer hospital stay. Moreover, lower urine output is associated with longer hospital stay. Whether these are the cause of complications or the result of them remains unclear.
. [J]. Hepatobiliary Pancreat Dis Int, 2018, 17(5): 402-407.
Martin D, Lykoudis PM, Jones G, Highton D, Shaw A, James S, Wei Q, Fusai G. Impact of postoperative intravenous fluid administration on complications following elective hepato-pancreato-biliary surgery. Hepatobiliary Pancreat Dis Int, 2018, 17(5): 402-407.
2018, Vol. 17 
