The association between high‐volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection

Abstract

Background: Traditional intraoperative fluid administration practices have been challenged this century with data suggesting improved outcomes with restrictive or goal-directed fluid administration during adult bowel surgery. Minimal data on outcomes associated with differing intraoperative fluid administration practice exists for pediatric patients. Aims:We assessed factors and outcomes associated with high-volume fluid administration in pediatric patients undergoing colectomy. We hypothesized that high-volume fluid administration is associated with impaired recovery and, thus, increased length of stay. Methods:A database of perioperative practice and postoperative outcomes at a tertiary pediatric hospital was queried for colectomy encounters between July 2012 and March 2017. Data extracted included patient characteristics, perioperative clinical data, and postoperative outcomes. Encounters were stratified into two groups: greater than 90th percentile fluids administered (high-volume fluid administration group) vs less than 90th percentile fluids administered. Univariable tests, multivariable logistic regression, and propensity score matched group comparisons were used to asses outcomes associated with high-volume fluid administration. Results:A total of 209 colectomy encounters were identified from which 12 were excluded based on predetermined criteria. High-volume fluid administration was associated with length of stay >6 days (AOR 8.14, CI 1.75-37.8, P = 0.007), time to first meal >4 days (AOR of 5.91, CI 1.30-27.17, P = 0.02), and supplemental oxygen requirement >24 hours (AOR 3.60, CI 1.25-10.39, P = 0.02) after adjusting for ASA status, blood loss, transfusion, and open surgery. Similarly, propensity score matched patients with high-volume fluid administration vs controls were more likely to have length of stay >6 days (93% vs 54%, P = 0.007), time to first meal >4 days (93% vs 57%, P = 0.009), and supplemental oxygen requirement >24 hours (36% vs 12%, P = 0.033). Conclusion:High-volume fluid administration during colectomy for pediatric patients is associated with worsened postoperative outcomes suggestive of impaired recovery.

Intraoperative fluid administration volumes during pediatric liver transplantation and postoperative outcomes: A multicenter analysis

“…Whether more restrictive or more liberal fluid management strategies should be used, with vasoactive agents utilized more frequently in lieu of fluid resuscitation, has been hotly debated in several clinical scenarios including liver transplantation. [2][3][4][5][6]18,19 Furthermore, fast tracking pediatric liver transplant recipients with early extubation is a management strategy that is increasingly sought after, with intraoperative fluid management potentially playing a role. 12,14,20,21 We may require more tailored fluid management strategies during pediatric liver transplantation, but the best methods for predic- The retrospective nature of our study has inherent limitations due to potential inaccuracies in charting.…”

“…Increasing attention is being paid to liberal and conservative fluid management strategies in abdominal and nonabdominal surgeries and their impact on postoperative outcomes in both adults and children. [2][3][4][5][6] Adult liver transplant studies have indicated an association between liberal fluid administration and postoperative respiratory complications as well as duration of mechanical ventilation. 7 To date, no pediatric liver transplant studies have examined this association.…”

“…Fluid management is an important part of the anesthetic care of these children, and unlike many other facets, is under the direct control of the clinical team. Increasing attention is being paid to liberal and conservative fluid management strategies in abdominal and nonabdominal surgeries and their impact on postoperative outcomes in both adults and children 2–6 . Adult liver transplant studies have indicated an association between liberal fluid administration and postoperative respiratory complications as well as duration of mechanical ventilation 7 .…”

Enhanced recovery after surgery in paediatrics: a review of the literature

“…Specifically, giving fluids greater than 90th percentile overall was associated with LOS >6 days (odds ratio [OR], 8.14; 95% confidence interval [CI], 1.75e37.8; p¼0.007), time to first meal >4 days (OR, 5.91; 95% CI, 1.30e27.17; p¼0.02) Enhanced recovery after surgery in paediatrics BJA Education -Volume 20, Number 7,2020 and supplemental oxygen requirement >24 h (adjusted OR [AOR], 3.60; 95% CI, 1.25e10.39; p¼0.02), after adjusting for ASA status, blood loss, transfusion and open surgery. 15 The American Society for Enhanced Recovery makes several recommendations for adult colorectal surgery that may apply to paediatric patients, including avoidance of fluid administration for intraoperative oliguria (but not anuria), administering fluid to address specific clinical problems and avoiding fluid administration for treatment of an isolated abnormal haemodynamic value. 16 ERAS principles such as reduced fasting and avoiding MBP have decreased the intravascular volume deficits, and fluid needs and administration must be adjusted accordingly.…”

Redefining the primary dependent variable

“…Sir —In a recent article, Sanford et al showed a correlation between volume of crystalloid and colloid administered intraoperatively and a host of outcome variables for pediatric patients undergoing colectomy. However, some questions come to mind regarding the design of this study.…”