Highlights
- •A cohort of patients undergoing pancreaticoduodenectomy was grouped by postoperative fluid resuscitation and compared for major adverse events.
- •More positive fluid balance on postoperative days 0, 1, and 2 was significantly associated with incidence of major adverse events, ICU admission, and length of stay.
- •The association between fluid balance and adverse events diminished over the postoperative period and was not present by postoperative day 3.
- •Restrictive fluid resuscitation following pancreaticoduodenectomy may improve postoperative outcomes.
Abstract
Background
Pancreaticoduodenectomy remains a major undertaking with substantial perioperative
morbidity and mortality. Previous studies in the colorectal population have noted
a correlation between excessive postoperative fluid resuscitation and anastomotic
complications. This study sought to assess the relationship between perioperative
fluid management and clinical outcomes in patients undergoing pancreaticoduodenectomy.
Methods
Data from a single institution, prospective database over a 10-year period (2002 to
2012) were reviewed. Patients were compared for perioperative fluid balance and postoperative
outcomes. Multivariable analysis was performed to assess the relationship between
perioperative fluid administration and incidence of major adverse events.
Results
Higher positive fluid balance on postoperative day 0, postoperative day 1, and postoperative
day 2 was associated with increased incidence of major adverse events, increased postoperative
intensive care unit admission, and longer hospital stay. Higher positive fluid balance
on postoperative day 0 was most strongly associated with postoperative morbidity (odds
ratio 1.39, confidence interval 1.16 to 1.66, P = .0003). Fluid balance on postoperative day 3 was not associated with adverse events.
Conclusions
Increased early perioperative fluid resuscitation is associated with major adverse
events in patients undergoing pancreaticoduodenectomy. More restrictive fluid administration
may improve postoperative outcomes; further prospective clinical trials focused on
fluid resuscitation and goal-directed therapy are needed.
Keywords
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Article info
Publication history
Published online: July 16, 2015
Received in revised form:
April 9,
2015
Received:
February 4,
2015
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
