Effect of perioperative fluid volume restriction on the incidence of complications following pancreaticoduodenectomy

Park, Jangho; Han, Sung‐Sik; Park, Joon Seong; Kang, Mee Joo; Park, Hyeong Min; Yu, Jing; Kim, Sun‐Whe

doi:10.1111/ans.17751

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…While there is conflicting evidence, some trials have demonstrated benefits and reduced postoperative complications and length of stay in patients with restrictive fluid regimens [ 13 , 15 , 31 ]. Other studies, consistent with our data, have failed to reproduce these benefits [ 9 , 12 , 29 , 32 ].…”

Section: Discussionsupporting

confidence: 88%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Lydon,

Shah,

Mongan

et al. 2024

J Anesth Analg Crit Care

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Background Pancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery. Methods This retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018–December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes. Results AKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI Risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8–35.1) and the AKI Risk score (OR = 6.3, 95% C.I. 2.4–16.4) were associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality. Conclusion In this analysis, intraoperative volume administration, vasopressor therapy, and a blood pressure < 55 mmHg for more than 10 min were not associated with an increased risk of AKI. After multivariate analysis, male gender and an elevated AKI Risk score were associated with an increased likelihood of AKI.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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

Lydon,

Shah,

Mongan

et al. 2024

J Anesth Analg Crit Care

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“…[13,15,32] Other studies, consistent with our data, have failed to reproduce these bene ts. [9,12,30,33] Large-scale studies of noncardiac surgeries have shown a positive association between low blood pressure and AKI and other adverse clinical outcomes. [2,23,34] There has been limited investigation of the impact of low blood pressure in pancreatic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Intraoperative improvements in uid and blood pressure management may further reduce the overall rate of postoperative complications, including pancreatic stula and Clavien-Dindo complications. [9][10][11][12][13][14][15] Implementing enhanced recovery pathways for pancreatic surgery incorporates many evidence-based activities that have improved clinical outcomes and reduced costs.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

Lydon,

Shah,

Mongan

et al. 2024

Preprint

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BACKGROUND Pancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery.METHODS This retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018- December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes.RESULTS AKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8–35.1) and the AKI risk score (OR = 6.3, 95% C.I. 24-16.4) were highly associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality.CONCLUSION Factors such as gender and an AKI RISK score were associated with an increased likelihood of AKI. The development of AKI or a CR-POPF was associated with longer length of stay, discharge to a skilled nursing facility, or death. However, no modifiable volume, vasopressor, or blood pressure targets were identified to decrease the risk of AKI or CR-POPF.

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“…A growing number of studies have recommended restrictive fluid replacement to avoid potential risk factors in the perioperative period, reduce postoperative complications, and improve prognosis. 14 , 15 Fluid loss can be induced by primary diseases, anesthesia, surgery, and bleeding. The volume of fluid infusion and the types of electrolytes replaced by infusion should be respectively matched with the volume and electrolyte composition of the fluid lost.…”

Section: Discussionmentioning

confidence: 99%

Comparisons of Electrolyte Balance Efficacy of Two Gelatin-Balanced Crystalloid for Surgery Patients Under General Anesthesia: A Multi-Center, Prospective, Randomized, Single-Blind, Controlled Study

Duan,

Deng,

et al. 2023

IJGM

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Purpose This study aimed to compare the electrolyte balance efficacies of two Gelatin-Balanced Crystalloid in clinical applications. Methods A multi-center, prospective, randomized, single-blind, parallel controlled study was conducted among non-cardiac surgery patients, with clinical registration number ChiCTR2200062999. They were randomized into Succinylated Gelatin, Multiple Electrolytes and Sodium Acetate Injection (SG-MESAI) group (experimental group) and Succinylated Gelatin Injection (SGI) infusion group (control group). The same anesthetic induction technique, anesthetic method, and calculation method for the volume of colloid infusion were used in the two groups. Between-group differences in the changes in base excess (BE), Chloride ion (Cl − ), bicarbonate radical (HCO 3 ⁻) and other parameters were recorded at 15 min, 30 min after the infusion relative to the baseline. Hemodynamic indicators were determined at 30 min after colloid infusion. Safety follow-up was conducted by administering the following tests within 48 h±12 h after surgery. Results A total of 225 subjects (full analysis set) were finally enrolled, with 110 subjects in the experimental group and 115 subjects in the control group. The baseline data were comparable between the two groups. At 15 min after infusion, the mean changes in BE, Cl − and HCO 3 ⁻ concentration in the experimental group were smaller than those of the control group (P<0.001). At 30 min after surgery, the mean changes in BE, Cl − , HCO 3 ⁻concentration and pH value were smaller in the experimental group than in the control group (P<0.05). The incidences of adverse events and adverse reactions in the experimental group was less than the control group, but the difference was not statistically significant (P≥0.05). Besides, no serious adverse events or adverse reactions were reported in any subjects. Conclusion Succinylated Gelatin, Multiple Electrolytes and Sodium Acetate Injection maintained the balance of BE, Cl − , HCO 3 ⁻ and pH value in a better way than Succinylated Gelatin Injection in non-cardiac surgery patients under general anesthesia.

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Effect of perioperative fluid volume restriction on the incidence of complications following pancreaticoduodenectomy

Cited by 3 publications

References 29 publications

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

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

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

Comparisons of Electrolyte Balance Efficacy of Two Gelatin-Balanced Crystalloid for Surgery Patients Under General Anesthesia: A Multi-Center, Prospective, Randomized, Single-Blind, Controlled Study

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