Effects of intraoperative fluid balance during pancreatoduodenectomy on postoperative pancreatic fistula: an observational cohort study

Abstract

Background Perioperative fluid management during major abdominal surgery has been controversial. Postoperative pancreatic fistula (POPF) is a critical complication of pancreaticoduodenectomy (PD). We conducted a retrospective cohort study to analyze the impact of intraoperative fluid balance on the development of POPF. Methods This retrospective cohort study enrolled 567 patients who underwent open pancreaticoduodenectomy, and the demographic, laboratory, and medical data were recorded. All patients were categorized into four groups according to quartiles of intraoperative fluid balance. Multivariate logistic regression and restricted cubic splines (RCSs) were used to analyze the relationship between intraoperative fluid balance and POPF. Results The intraoperative fluid balance of all patients ranged from -8.47 to 13.56 mL/kg/h. A total of 108 patients reported POPF, and the incidence was 19.0%. After adjusting for potential confounders and using restricted cubic splines, the dose‒response relationship between intraoperative fluid balance and POPF was found to be statistically insignificant. The incidences of bile leakage, postpancreatectomy hemorrhage, and delayed gastric emptying were 4.4%, 20.8%, and 14.8%, respectively. Intraoperative fluid balance was not associated with these abdominal complications. BMI ≥ 25 kg/m2, preoperative blood glucose < 6 mmol/L, long surgery time, and lesions not located in the pancreas were independent risk factors for POPF. Conclusion The study did not find a significant association between intraoperative fluid balance and POPF. Well-designed multicenter studies are necessary to explore the association between intraoperative fluid balance and POPF.

Influence of different intraoperative fluid management on postoperative outcome after abdominal tumours resection

“…The study found that fluid balance was significantly associated with the development of POPF, highlighting the importance of appropriate fluid management in pancreatic surgery. 31 …”

“…The study found that fluid balance was significantly associated with the development of POPF, highlighting the importance of appropriate fluid management in pancreatic surgery. 31 In addition, questions are raised about what the optimal goals of hemodynamic parameters (healthy population-derived normal values, preoperative values, maximal values) should be. Studies have shown that optimising cardiac output and oxygen delivery to higher values intraoperatively (supranormal) did not affect postoperative complications rate, intensive care unit stay, or hospital stay length.…”