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

Abstract

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.

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

“…Some studies tend to support restrictive fluid management, but the controversy over fluid management has never ceased. Zhang et al enrolled 301 patients for a retrospective study, and the results showed that higher postoperative fluid balance appeared to be associated with morbidity after PD, systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), bleeding, and heart failure [17]. However, Meyhoff et al performed an international, randomized trial among adult patients with septic shock in the ICU and found that intravenous fluid restriction did not decrease mortality at 90 days compared with standard intravenous fluid therapy [18].…”

Effects of Intraoperative Fluid Balance During Pancreatoduodenectomy on Postoperative Pancreatic Fistula: An Observational Cohort Study

“…Some studies tend to support restrictive uid management, but the controversy over uid management has never ceased. Zhang et al enrolled 301 patients for a retrospective study, and the results showed that higher postoperative uid balance appeared to be associated with morbidity after PD, systemic in ammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), bleeding, and heart failure (17). However, Meyhoff et al performed an international, randomized trial among adult patients with septic shock in the ICU and found that intravenous uid restriction did not decrease mortality at 90 days compared with standard intravenous uid therapy (18).…”

Significance of geriatric nutritional risk index and neutrophil-to-lymphocyte ratio as prognostic indicators in older patients with gastric cancer: A retrospective cohort study

“…Previous studies have demonstrated that preoperative undernutrition is associated with postoperative complications and poor prognoses in patients with malignant diseases [3][4][5]. The geriatric nutritional risk index (GNRI), which is calculated from serum albumin level and body mass index (BMI), was rst reported by Bouilanne et al for assessing nutritional status in older patients [6].…”