Intraoperative Fluid Restriction in Pancreatic Surgery: A Double Blinded Randomised Controlled Trial

Samkar, Ganapathy van; Eshuis, Wietse J.; Bennink, Roelof J.; Gulik, Thomas M. van; Dijkgraaf, Marcel G. W.; Preckel, Benedikt; Hert, Stefan De; Gouma, Dirk J.; Hollmann, Markus W.; Busch, Olivier R.

doi:10.1371/journal.pone.0140294

Cited by 26 publications

(24 citation statements)

References 38 publications

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“…As shown by our qualitative analysis, neither the perioperative intakes nor the fluid balance or the bodyweight gain has been consistently reported in the considered RCTs. Surprisingly, the overall fluid balance or the postoperative weight difference, which should be, in principle, the most effective perioperative variables depicting the fluid paths of restrictive and liberal subgroups, has been reported only in 5 studies (27.7%) [ 16 , 33 , 35 , 46 , 47 ]. The heterogeneity in actual overall fluid balance computation, as long the definition of postoperative complications (see further) greatly affects the comparability of the RCTs, soliciting clear standards in data reporting.…”

Section: Discussionmentioning

confidence: 99%

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

et al. 2021

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Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value = 0.001]. We found no difference in either early (p value = 0.33) or late (p value = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059.

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Section: Discussionmentioning

confidence: 99%

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

et al. 2021

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“… R: 2050 (650–5130); Kolloid: 390 (0–2500) L: 3563 (1050–7550); Kolloid: 363 (0–4000) Kristalloide, Albumin 5 % Keine signifikanten Unterschiede bei perioperativen Komplikationen Van Samkar et al. (2015) [ 133 ] [Intraop.] Pankreas R: 26 S: 22 R: 289 (78) S: 248 (104) R: 1100 ± 600 S: 1000 ± 800 R: 2000 (1400–2400); Kolloid: 1400 ± 600 S: 2500 (1700–3600); Kolloid: 1000 ± 600 RL + HES Keine Unterschiede bei der Magenentleerungszeit Myles et al.…”

Section: Perioperatives Flüssigkeitsmanagementunclassified

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

et al. 2020

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Zusammenfassung Die Gabe intravasaler Flüssigkeiten gehört zu den Grundpfeilern der perioperativen Therapie und nimmt insbesondere bei großen viszeralchirurgischen Eingriffen maßgeblichen Einfluss auf das chirurgische Behandlungsergebnis. Ein adäquates perioperatives Flüssigkeitsmanagement kann durch Vermeidung von Hypo- und Hypervolämie dazu beitragen, das Risiko einer unzureichenden Gewebeperfusion als Treiber postoperativer Morbidität und Letalität signifikant zu reduzieren. Der effektive Umgang mit intravasal zugeführten Flüssigkeiten setzt dabei die Kenntnis der Substanzen sowie Maßnahmen zur Therapiesteuerung voraus. Das Flüssigkeitsmanagement beginnt bereits präoperativ und sollte – unter Nutzung einer an die Bedürfnisse des Patienten angepassten und dem Eingriff entsprechenden hämodynamischen Überwachung – auch postoperativ im Aufwachraum und auf Station fortgesetzt werden. Der Kommunikation aller an der perioperativen Versorgung Beteiligten kommt im Sinne eines optimalen Flüssigkeitsmanagements eine entscheidende Bedeutung zu.

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“…[1][2][3] However, there have been only limited studies regarding fluid restriction in pancreatic resection, and the results are controversial. [6][7][8][9][10][11][12][13] This study was performed to investigate the effects of perioperative fluid restriction in PD. Contrary to our expectations, our results did not indicate a relationship between fluid restriction and a decrease in complications or the LoS.…”

Section: Discussionmentioning

confidence: 99%

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

Park

Han

Park

et al. 2022

ANZ Journal of Surgery

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Background: Perioperative fluid restriction has been suggested to reduce morbidity and length of stay. The purpose of this study was to compare the morbidity following pancreaticoduodenectomy (PD) between fluid restriction group and conventional management group. Methods: Seventy-two patients were enrolled for perioperative fluid restriction of PD. During the operation, main fluid was infused at a rate of less than 8 mL/kg/hr. Until POD#3, 10% dextrose and Hartmann's solution were administered at rates of 40 mL/h and {(1.5*body weight) À 42} mL/h, respectively. The historical control group consisted of 139 patients. We compared the rates of major complication (Clavien-Dindo grade III to V) and clinically relevant postoperative pancreatic fistula (CR-POPF), length of hospital stays (LOS), amount of urine output, and the rate of acute kidney injury (AKI). Results: The rates of major complication (19.0% versus 18.7%; p > 0.999), CR-POPF (15.5% versus 15.1%; p > 0.999), and LOS (19 days [range: 10-52] versus 19 days [range: 11-75]; p = 0.514) were comparable in the study and the control group, respectively. Amount of urine output during the operation and from POD#1 to POD#3 was more than minimal amount (0.5 mL/kg/hr) in the both groups. Incidence rate of AKI in the study group was not higher than the control group (Stage I: 1.7% versus 2.9%, p > 0.999; stage II: 0% versus 1.4%, p > 0.999). Conclusion: There was no decrease in incidence of morbidity including POPF following PD with perioperative fluid restriction. Fluid restriction was feasible because it did not reduce urine output and did not increase incidence of AKI.

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Intraoperative Fluid Restriction in Pancreatic Surgery: A Double Blinded Randomised Controlled Trial

Cited by 26 publications

References 38 publications

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

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

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