Prospective Randomized Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy

Grant, Florence; Brennan, Murray F.; Allen, Peter J.; DeMatteo, Ronald P.; Kingham, T. Peter; D’Angelica, Michael I.; Fischer, Mary; Gönen, Mithat; Zhang, Hao; Jarnagin, William R.

doi:10.1097/sla.0000000000001846

Cited by 44 publications

(29 citation statements)

References 32 publications

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“…This evidence let us speculate that, probably, reduced functional reserves represent a potential risk factor for cardiovascular and pulmonary complications and, consequently, for mortality [23,24]. However, a dedicated perioperative management and a perioperative fluid intervention with an individualized "goal-directed" fluid balance could prevent the onset of such disorders in this subset of patients, demonstrating that major surgery, such as pancreatic resections, need good expertise and high-volume series both on the "surgical side" and on anesthesiologic management [23,[25][26][27]. Data regarding oncological outcomes after pancreatic surgery for malignancies in the elderly are controversial so far.…”

Section: Discussionmentioning

confidence: 99%

Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

Gruppo

Tolin

Franzato

et al. 2020

Gastroenterology Research and Practice

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Background. Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods. 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results. A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p=0.004), Karnofsky Score (p=0.025), preoperative jaundice (p=0.004), and pulmonary complications (p=0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p=0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p=0.909). Conclusion. PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.

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Section: Discussionmentioning

confidence: 99%

Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

Gruppo

Tolin

Franzato

et al. 2020

Gastroenterology Research and Practice

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“…Multiple studies have also been conducted in non-cardiac surgeries comparing a restricted vs. liberal perioperative fluid administration approach. Some of these included pancreatectomy, abdominal vascular surgery, colonic surgery, lung resection, pancreaticoduodenectomy, and major abdominal surgery (González-Fajardo, Mengibar, Brizuela, Castrodeza, & Vaquero-Puerta, 2009;Grant et al, 2016;Holte et al, 2007;Matot et al,2013;van Samkar et al, 2015;Vermeulen, Hofland, Legemate, & Ubbink, care"; however, what constituted usual or standard care itself was variable. The hemodynamic parameters used, as well as the devices used to predict fluid needs in the GDT approach, also varied between studies.…”

Section: Background/statement Of the Problemmentioning

confidence: 99%

An Integrative Review of Fluid Management in Cardiac Surgery

George¹

2018

Preprint

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Adequate fluid administration during and after cardiac surgery is essential to ensure adequate oxygen delivery to the tissues, while simultaneously avoiding the dangers of hypervolemia and fluid overload. In both cardiac and non-cardiac surgery there has been debate on what the best approach to fluid management is, what hemodynamic parameters should be used to assess fluid requirements, and what type of fluids should be used. There are several studies in non-cardiac surgery that examine these issues, while they are fewer in the field of cardiac surgery. An integrative review design was used to examine the current evidence on fluid management practices in cardiac surgery. Thirteen studies were included in this review. They included four studies of surveys on fluid management practices, eight studies that utilized goal directed therapy (GDT), and one observational study on fluid administration practices in cardiac surgical patients. The results showed that arterial blood pressure (ABP), central venous pressure (CVP), and echocardiography were used most often to monitor volume status. Crystalloids were used most frequently for volume replacement. In the studies utilizing GDT, fluid administration was often based on stroke volume variation (SVV) and cardiac index (CI) goals. A slight trend towards increased fluid administration was seen in the GDT groups. Fluid bolus volumes ranged from 100 to 500 ml. The GDT groups had a slight trend toward decreased length of both hospital and ICU stay. An important limitation of the review was that none of the studies were conducted in the United States of America.

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“…Because of intraoperative blood and insensible losses, third spacing, and fluid redistribution, fluid administration is a key aspect of intraoperative care to maintain intravascular circulating volume and electrolyte homeostasis. [1][2][3] Intraoperative fluid administration for patients undergoing intra-abdominal surgery might affect postoperative organ function and out-come 4,5 and is largely under the control of anesthesia providers. To date, scarce evidence and few specific clinical guidelines exist to guide this practice.…”

Section: Introductionmentioning

confidence: 99%

Crystalloid Administration Is Associated with the Recovery of Pediatric Elective Roux-en-Y Hepaticojejunostomy

2019

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Introduction Intraoperative fluid administration is important for postoperative recovery and might be associated with postoperative complications. Materials and Methods This retrospective review included 471 patients who underwent Roux-en-Y hepaticojejunostomy. Patients were separated into two groups based on whether they received low (<15.27 mL/kg/h) or high (>15.27 mL/kg/h) volumes of corrected crystalloid fluids. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 192 matched patients, clinical outcomes, including postoperative complications and length of hospital stay, were compared. Results Higher use of diuresis (p = 0.027) was found in the high fluid group. Receiving low volumes of crystalloids was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.31–1.07; p = 0.047) and first bowel movement (OR, 0.56; 95% CI, 0.38–0.98; p = 0.013). However, the occurrence of renal complications did not show significant differences between the groups. A lower postoperative complication rate (OR, 0.54; 95% CI, 0.42–0.94; p = 0.016) was noted in patients with low crystalloids compared with high crystalloids. The total length of hospital stay was longer in patients with high crystalloid fluid (9.21 ± 3.24 days) than patients with low volumes (7.83 ± 2.58 days; p = 0.012). Conclusion Low crystalloid fluid administration was associated with favorable postoperative outcomes.

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Prospective Randomized Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy

Cited by 44 publications

References 32 publications

Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

An Integrative Review of Fluid Management in Cardiac Surgery

Crystalloid Administration Is Associated with the Recovery of Pediatric Elective Roux-en-Y Hepaticojejunostomy

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