Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

Pache, Basile; Solà, Josep; Hahnloser, Dieter; Demartines, Nicolas; Grass, Fabian

doi:10.1111/codi.14465

Cited by 17 publications

(22 citation statements)

References 34 publications

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“…The present study aimed to evaluate whether fluid‐management related thresholds could help in guidance during urgent colectomy performed within an ERAS protocol, in line with previous reports of our group for elective procedures . Interestingly, two very similar thresholds for overall complications in 224 patients undergoing urgent colonic resections were identified: intraoperative fluid administration of more than 3 L and weight gain at POD 2 of more than 2.3 kg.…”

Section: Discussionsupporting

confidence: 56%

“…No elective resections were considered for the present analysis. No patient overlap exists therefore with the published cohorts of elective laparoscopic and open resections . Details regarding data management within our institutional ERAS pathway and contents of the database have been previously described .…”

Section: Methodsmentioning

confidence: 99%

“…Three parameters were assessed: intravenous (IV) volume administration at the day of surgery until midnight (including cristalloids, colloids, and blood products), the amount of intraoperatively administered IV fluids, calculated in mL/kg/h, and postoperative weight (through postoperative (POD) 1‐3) providing that patients were sufficiently stable and mobile to be weighed. All three fluid‐related parameters were analysed to identify meaningful cut‐off values for postoperative complications (overall, severe) through receiver operating characteristics (ROC) analysis, in line with previously described methodology …”

Section: Methodsmentioning

confidence: 99%

“…Statistical and Machine Learning Toolbox of MATLAB R2018a (Mathworks, Natick, Massachusetts 01760, USA) was used to compute above defined fluid‐related parameters, in line with methodology for elective thresholds . In the second step, endpoints overall and major complications and postoperative mortality were compared among patients above and below identified thresholds.…”

Section: Methodsmentioning

confidence: 99%

“…Optimal fluid management during colorectal surgery is a matter ofongoing debate . To provide a guiding tool for clinical practice, our group recently identified thresholds for elective laparoscopic and open colorectal resections: administration of >3 L of IV fluids at the day of surgery and exceeding 2.5 kg weight gain at postoperative day (POD) 2 for laparoscopic, respectively, 3.5 kg for open resections was associated with postoperative adverse events.…”

Section: Introductionmentioning

confidence: 99%

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Fluid management for critical patients undergoing urgent colectomy

Grass¹,

Pache²,

Butti³

et al. 2019

Evaluation Clinical Practice

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Rationale:The present study aimed to define thresholds for perioperative fluids and weight gain after urgent colectomies. Method: Consecutive urgent colonic resections within an enhanced recovery pathway (2011-2017) were included. Primary outcomes were postoperative complications, stratified as overall (I-V) and major (IIIb-V) according to Clavien scale. Fluid-management-related thresholds were identified through receiver operating characteristics (ROC) analysis. Outcomes were compared for patients above vs below threshold, and multivariable logistic regression was performed to identify risk factors for overall complications. Results: Overall, complications were observed in 133 out of 224 patients (59%), severe complications in 43 patients (19%). For overall complications, area under ROC (AUROC) was 0.71, identifying a critical cut-off of 3 L of total IV fluid administration at the day of surgery (negative predictive value [NPV]: 90%). Further, a critical cut-off for postoperative weight gain of 2.3 kg at postoperative day (POD) 2 wasidentified (AUROC 0.7, NPV 92%). Multivariable analysis identified fluid administration of >3 L (OR 5.33; 95% CI, 2.36-12.02) and weight gain of >2.3 kg at POD 2 (OR 2.5; 95% CI, 1.13-5.53) as independent predictors for overall complications.Median length of stay was 7 (5-10) days in patients receiving <3 L at POD 0 and 13 (9-19) days in patients receiving >3 L (P < .001).Conclusions: Fluid administration of 3 L at the day of surgery and weight gain of 2.3 kg at POD 2 may represent critical thresholds for adverse outcomes after urgent colectomy. The suggested thresholds need to be confirmed through independent validation.

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Section: Discussionsupporting

confidence: 56%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Fluid management for critical patients undergoing urgent colectomy

Grass¹,

Pache²,

Butti³

et al. 2019

Evaluation Clinical Practice

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Identification of patients eligible for discharge within 48 h of colorectal resection

Grass

Mathis

Hahnloser

et al. 2020

British Journal of Surgery

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Background This study aimed to identify patients eligible for a 48‐h stay after colorectal resection, to provide guidance for early discharge planning. Methods A bi‐institutional retrospective cohort study was undertaken of consecutive patients undergoing major elective colorectal resection for benign or malignant pathology within a comprehensive enhanced recovery pathway between 2011 and 2017. Overall and severe (Clavien–Dindo grade IIIb or above) postoperative complication and readmission rates were compared between patients who were discharged within 48 h and those who had hospital stay of 48 h or more. Multinominal logistic regression analysis was performed to ascertain significant factors associated with a short hospital stay (less than 48 h). Results In total, 686 of 5122 patients (13·4 per cent) were discharged within 48 h. Independent factors favouring a short hospital stay were age below 60 years (odds ratio (OR) 1·34; P = 0·002), ASA grade less than III (OR 1·42; P = 0·003), restrictive fluid management (less than 3000 ml on day of surgery: OR 1·46; P < 0·001), duration of surgery less than 180 min (OR 1·89; P < 0·001), minimally invasive approach (OR 1·92; P < 0·001) and wound contamination grade below III (OR 4·50; P < 0·001), whereas cancer diagnosis (OR 0·55; P < 0·001) and malnutrition (BMI below 18 kg/m2: OR 0·42; P = 0·008) decreased the likelihood of early discharge. Patients with a 48‐h stay had fewer overall (10·8 per cent versus 30·6 per cent in those with a longer stay; P < 0·001) and fewer severe (2·6 versus 10·2 per cent respectively; P < 0·001) complications, and a lower readmission rate (9·0 versus 11·8 per cent; P = 0·035). Conclusion Early discharge of selected patients is safe and does not increase postoperative morbidity or readmission rates. In these patients, outpatient colorectal surgery should be feasible on a large scale with logistical optimization.

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Correlation of postoperative fluid balance and weight and their impact on outcomes

Butti

Pache

Winiker

et al. 2020

Langenbecks Arch Surg

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Introduction Normovolemia after major surgery is critical to avoid complications. The aim of the present study was to analyze correlation between fluid balance, weight gain, and postoperative outcomes. Methods All consecutive patients undergoing elective or emergency major abdominal surgery needing intermediate care unit (IMC) admission from September 2017 to January 2018 were included. Postoperative fluid balances and daily weight changes were calculated for postoperative days (PODs) 0–3. Risk factors for postoperative complications (30-day Clavien) and prolonged length of IMC and hospital stay were identified through uni- and multinominal logistic regression. Results One hundred eleven patients were included, of which 55% stayed in IMC beyond POD 1. Overall, 67% experienced any complication, while 30% presented a major complication (Clavien ≥ III). For the entire cohort, median cumulative fluid balance at the end of PODs 0–1–2–3 was 1850 (IQR 1020–2540) mL, 2890 (IQR 1610–4000) mL, 3890 (IQR 2570–5380) mL, and 4000 (IQR 1890–5760) mL respectively, and median weight gain was 2.2 (IQR 0.3–4.3) kg, 3 (1.5–4.7) kg, and 3.9 (2.5–5.4) kg, respectively. Fluid balance and weight course showed no significant correlation (r = 0.214, p = 0.19). Extent of surgery, analyzed through Δ albumin and duration of surgery, significantly correlated with POD 2 fluid balances (p = 0.04, p = 0.006, respectively), as did POD 3 weight gain (p = 0.042). Prolonged IMC stay of ≥ 3 days was related to weight gain ≥ 3 kg at POD 2 (OR 2.8, 95% CI 1.01–8.9, p = 0.049). Conclusion Fluid balance and weight course showed only modest correlation. POD 2 weight may represent an easy and pragmatic tool to optimize fluid management and help to prevent fluid-related postoperative complications.

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Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

Cited by 17 publications

References 34 publications

Fluid management for critical patients undergoing urgent colectomy

Fluid management for critical patients undergoing urgent colectomy

Identification of patients eligible for discharge within 48 h of colorectal resection

Correlation of postoperative fluid balance and weight and their impact on outcomes

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