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

Abstract

BackgroundThere is limited information on the impact on perioperative fluid intervention on complications and length of hospital stay following pancreaticoduodenectomy. Therefore, we conducted a detailed analysis of fluid intervention in patients undergoing pancreaticoduodenectomy at a university teaching hospital to test the hypothesis that a restrictive intravenous fluid regime and/or a neutral or negative cumulative fluid balance, would impact on perioperative complications and length of hospital stay.MethodsWe retrospectively obtained demographic, operative details, detailed fluid prescription, complications and outcomes data for 150 consecutive patients undergoing pancreaticoduodenectomy in a university teaching hospital. Prognostic predictors for length of hospital stay and complications were determined.ResultsOne hundred and fifty consecutive patients undergoing pancreaticoduodenectomy were evaluated between 2006 and 2012. The majority of patients were, middle-aged, overweight and ASA class III. Postoperative complications were frequent and occurred in 86 patients (57%). The majority of complications were graded as Clavien-Dindo Class 2 and 3. Postoperative pancreatic fistula occurred in 13 patients (9%), and delayed gastric emptying occurred in 25 patients (17%). Other postoperative surgical complications included sepsis (22%), bile leak (4%), and postoperative bleeding (2%). Serious medical complications included pulmonary edema (6%), myocardial infarction (8%), cardiac arrhythmias (13%), respiratory failure (8%), and renal failure (7%). Patients with complications received a higher median volume of intravenous therapy and had higher cumulative positive fluid balances. Postoperative length of stay was significantly longer in patients with complications (median 25 days vs. 10 days; p < 0.001). After adjustment for covariates, a fluid balance of less than 1 litre on postoperative day 1 and surgeon caseloads were associated with the development of complications.ConclusionsIn the context of pancreaticoduodenectomy, restrictive perioperative fluid intervention and negative cumulative fluid balance were associated with fewer complications and shorter length of hospital stay. These findings provide good opportunities to evaluate strategies aimed at improving perioperative care.

Evaluating effects of pre-operative hydration on clinical outcome of patients undergoing orthopedic surgery

“…According to Brandstrup et al, 24 there was significantly fewer complications in the patients received restrictive fluids in comparison with the group with the standard regime of intravenous fluids. Similar results were reported in the studies conducted by Abraham-Nordling et al, 21 de Aguilar-Nascimento et al, 25 Kocian et al, 26 and Weinberg et al 27 However, Warrillow et al 28 stated that pre-operative fluid therapy is associated with more complications (about 57%) in major surgeries of digestive system. Of course, it should be noted that accompanying background diseases, as well as type and location of surgery, may be involved in emerging of complications independent from fluid therapy.…”

“…Similar to this study, de Aguilar-Nascimento et al 25 suggested that restrictive fluid therapy protocol leads to shorter hospitalization period. According to Weinberg et al, 27 restrictive fluid therapy is associated with shorter hospitalization period. Contrary to the above-mentioned findings, Abraham-Nordling et al 21 stated that restrictive pre-operative fluid therapy does not affect shorter hospitalization period.…”

Simple and reliable pancreatoenteroanastomosis

“…Профилактику развития панкреатической фистулы подкожным введением раствора октреотида (200 мкг за 1 ч до операции и в послеоперационном периоде в дозе 100 мкг 3 раза в день в течение 5-7 дней) использовали только в случае высокого риска несостоятельности панкреатоэнтероанастомоза -при неизмененной, мягкой или хрупкой ПЖ с узким (до 3 мм) протоком. Важным мы считали ограничение введения жидкости: во время и после операции водный баланс должен быть около нуля, не превышая его более чем на 500 мл [25,61]. Этап 1.…”

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

“…Nevertheless, maintaining adequate intravascular fluid is crucial for normal organ perfusion. Inappropriate intravascular fluid intervention is strongly associated with postoperative complications after major abdominal surgery [24][25][26][27][28][29][30] . However, the safety of fluid in the perioperative period of abdominal surgery remains unclear [31][32][33][34] .…”