Perioperative Fluid Prescription, Complications and Outcomes in Major Elective Open Gastrointestinal Surgery

Abstract

Perioperative fluid therapy and associated outcomes of patients undergoing major elective open gastrointestinal surgery are poorly understood. This study measured perioperative fluid therapy, complication rates and outcomes for major elective open gastrointestinal surgery in a tertiary care hospital. We obtained demographic data, operative details, fluid prescription, complications and outcomes in 100 patients. Patients were elderly and had multiple comorbidities. Median delivered intraoperative fluid volume was 4.2 litres, followed by 6.3 litres over the subsequent 24 hours. Perioperative fluid prescription was associated with a positive fluid balance. Complications occurred in 57% of patients with 32% experiencing at least one major complication. Serious complications were substantially more frequent in patients having non-colorectal operations. The most common adverse events were pulmonary oedema (21%), ileus (18%), serious sepsis (17%), pneumonia (17%), arrhythmias (14%), delirium (14%) and wound healing problems (infections 13%, anastomotic leaks 12%). Mortality at 30 days was 2%. This study provides planning data for future interventional studies.

The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenectomy (Whipple’s procedure)

“…The demographic and clinical features of our patients are consistent with other studies of similar types of surgery [1,10-13]. Likewise our complication rates appear to be similar to other university hospital hepatobiliary units [14,15].…”

“…Multivariate analysis was undertaken using a backward stepwise logistic regression model to identify factors associated with postoperative discharge by day 14, including all factors where the P value was less than 0.1 on univariate analysis. A cut off of 14 days represented the median length of stay for patients undergoing uncomplicated PD at our institution [1]. Odds ratios (OR) and 95% confidence intervals (CI) were reported where appropriate.…”

“…It is recognized that liberal fluid administration is common practice after major hepatobiliary and pancreatic surgery [1]. However, there is limited information on perioperative fluid therapy and its impact on complications and length of hospital stay following pancreaticoduodenectomy (PD).…”

Improving outcomes for pancreatic cancer: radical surgery with patient-tailored, surgery-specific advanced haemodynamic monitoring

“…This technology has been endorsed by the National Health Service5 and is standard of care for all patients undergoing complex and prolonged hepatobiliary and pancreatic surgery in our institution. Previous research by our group has demonstrated that liberal fluid intervention in patients undergoing major pancreatic surgery is associated with a major complication rate of 50% 1. Inappropriate infusions of vasopressor agents in the setting of uncorrected hypovolaemia can lead to tissue hypoperfusion, organ dysfunction and ischaemia 6.…”

“…Even in experienced hands, perioperative morbidity rates are as high as 50% 1. We describe the perioperative management of a patient with pancreatic cancer and portal vein encasement.…”