Early postoperative fluid retention is a strong predictor for complications after pancreatoduodenectomy

Åkerberg, Daniel; Ansari, Daniel; Bergenfeldt, Magnus; Andersson, Roland; Tingstedt, Bobby

doi:10.1016/j.hpb.2019.05.003

Cited by 12 publications

(10 citation statements)

References 31 publications

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“…Consistent with other studies, we found that recipients with excessive FB have more complications [34][35][36][37][38]. The harmful effects of fluid overload are often manifested as pulmonary edema, pleural effusions, and cardiac overload, thereby putting patients at a high risk Figure 2 The eGFR at 1, 6, and 12 months after kidney transplantation in four fluid balance levels.…”

Section: Discussionsupporting

confidence: 86%

Early perioperative fluid overload is associated with adverse outcomes in deceased donor kidney transplantation

et al. 2021

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Kidney transplant recipients are often treated with a large volume of infusion to attain adequate graft perfusion in the early perioperative period. However, it remains unknown whether this fluid therapy is renal responsive or a contributing factor to fluid overload complications. We conducted a retrospective cohort analysis of all recipients who received deceased donor kidney transplantation at an academic teaching hospital from January 2015 to April 2019. Our exposure of interest was early perioperative fluid balance. The primary outcome was graft function at 1, 6, and 12 months after transplantation. The secondary outcome was cardiopulmonary and gastrointestinal complications. Fluid balance was not significantly correlated with graft function in short-or long-term periods. Postoperative complications were higher in recipients with increased fluid balance. Delayed graft function was significantly related to cardiopulmonary and gastrointestinal complications. Cardiovascular disease and high BMI of recipients were strong risk factors for cardiopulmonary complications. Fluid overload was prevalent in the early perioperative period of kidney transplantation. It did not promote renal recovery, but was associated with a high risk of complications. Our findings might be a useful indicator to optimize the perioperative fluid management of kidney transplant recipients.

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Section: Discussionsupporting

confidence: 86%

Early perioperative fluid overload is associated with adverse outcomes in deceased donor kidney transplantation

et al. 2021

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“…Early fluid retention in patients undergoing pancreatoduodenectomies has previously been associated to increased postoperative morbidity, and may represent an important factor in the early perioperative setting. 23,39 In this present study, we were unable to include information on perioperative fluid administration, which limits the assessment of postoperative weight change. While some evidence suggests that a liberal intraoperative fluid balance may be associated with an increased rate of postoperative morbidity after pancreatoduodenectomy, there are also convincing data showing how, in case of a high-risk pancreas, a near-zero fluid balance could lead to pancreatic stump ischemia, with increased postoperative pancreatic fistula and hyperamylasaemia rates.…”

Section: Discussionmentioning

confidence: 92%

“…A weight increase of ≥2 kg was considered clinically significant as this cut-off has previously been associated to an increased risk of postoperative complications. 23…”

Section: Outcomes Of Interestmentioning

confidence: 99%

Preoperative chronic kidney disease and complications after pancreatoduodenectomy: a retrospective cohort study

Swartling,

Evans,

Larsson

et al. 2023

ANZ Journal of Surgery

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BackgroundChronic kidney disease is a prevalent condition in surgical patients. Possible associations with increased postoperative morbidity and mortality have not been clearly demonstrated in patients undergoing pancreatoduodenectomy. The aim of this study was to assess the risk of postoperative complications in patients with reduced kidney function undergoing pancreatoduodenectomy.MethodsAll patients undergoing pancreatoduodenectomy at Karolinska University Hospital between 2008 and 2019 were retrospectively included. The variable of interest was chronic kidney disease, based on preoperative estimated glomerular filtration rate measurements. Unadjusted and adjusted logistic regression analyses were performed for standardized postoperative complications.ResultsA total of 971 patients were included in the study, of whom 92 (10%) had an estimated glomerular filtration rate < 60 mL/min/1.73m2, equivalent to chronic kidney disease Stage 3a or worse. Patients with chronic kidney disease had a higher odds of longer hospital stay (adjusted odds ratio 1.58, 95% confidence interval 1.00–2.50) and postoperative weight increase (adjusted odds ratio 2.02, 1.14–3.56). A 10 unit increase of preoperative estimated glomerular filtration rate was associated to lower odds of intensive care unit admission (adjusted odds ratio 0.81, 0.69–0.95), delayed gastric emptying (adjusted odds ratio 0.90, 0.81–0.99), and post‐operative pancreatic fistula (adjusted odds ratio 0.83, 0.74–0.94).ConclusionPatients undergoing pancreatoduodenectomy with decreased preoperative kidney function are more likely to experience major postoperative complications, and also postoperative weight increase. Preoperative kidney function assessment is important in risk stratification before pancreatoduodenectomies.

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“…The negative effects of excessive fluid overload in the postoperative period have long been recognized [13][14][15][16]. A contemporary randomized study investigating fluid regimens in patients undergoing colorectal surgery found that a restrictive fluid strategy not only led to decreased cardiopulmonary morbidity but also reduced the incidence of tissue-healing complications [17].…”

Section: Discussionmentioning

confidence: 99%

Postoperative fluid balance and outcomes after Pancreaticoduodenectomy: a retrospective study in 301 patients

Zhang

Feng

Suolang

et al. 2022

Langenbecks Arch Surg

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Background The incidence of postoperative morbidity after pancreaticoduodenectomy (PD) is high; however, whether fluid management after surgery affects postoperative morbidity is unclear. This study aimed to determine whether fluid balance in patients undergoing PD is associated with postoperative complications and mortality. Methods Data from a computer-based database of patients who underwent PD between 2016 and 2019 were retrospectively analyzed. Patients were stratified into four quartiles according to their fluid balance at 0–24, 24–48, 48–72, and 72–96 h after surgery. The predefined primary outcome measures were morbidity and mortality rates. Results A total of 301 patients were included. The morbidity and mortality rates in the cohort were 56.5% and 3.7%, respectively. The most common complications after PD were postoperative pancreatic fistula (31.9%) and delayed gastric emptying (31.6%). Patients with a higher fluid balance in the 0–24-, 24–48-, and 48–72-h postoperative periods had a higher morbidity rate and longer hospital stay than those with a lower fluid balance (all P < 0.05). Patients with a fluid balance of 4212 mL during the postoperative 0–72 h were most likely to develop complications (P < 0.001). The area under the receiver operating characteristic curve was 0.71 (0.65–0.77), with a sensitivity of 58.24% and a specificity of 77.10%. Conclusions Higher postoperative fluid balance seems to be associated with increased morbidity after PD compared to lower fluid balance. Surgeons should pay close attention to the occurrence of complications in patients with a high fluid balance.

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Early postoperative fluid retention is a strong predictor for complications after pancreatoduodenectomy

Cited by 12 publications

References 31 publications

Early perioperative fluid overload is associated with adverse outcomes in deceased donor kidney transplantation

Early perioperative fluid overload is associated with adverse outcomes in deceased donor kidney transplantation

Preoperative chronic kidney disease and complications after pancreatoduodenectomy: a retrospective cohort study

Postoperative fluid balance and outcomes after Pancreaticoduodenectomy: a retrospective study in 301 patients

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