Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality - Improving Standardized Practice.

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Version: Final published version
License: Not specified
Serval ID
serval:BIB_17BACF280F06
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality - Improving Standardized Practice.
Journal
Annals of surgery
Author(s)
Abd El Aziz M.A., Grass F., Calini G., Lovely J.K., Jacob A.K., Behm K.T., D'Angelo A.D., Shawki S.F., Mathis K.L., Larson D.W.
ISSN
1528-1140 (Electronic)
ISSN-L
0003-4932
Publication state
Published
Issued date
01/05/2022
Peer-reviewed
Oui
Volume
275
Number
5
Pages
891-896
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
We aimed to determine a safe zone of intraoperative fluid management associated with the lowest postoperative complication rates without increased acute kidney injury (AKi) risk for elective colorectal surgery patients.
To date, standard practice within institutions, let alone national expectations related to fluid administration, are limited. This fact has perpetuated a quality gap.
Elective colorectal surgeries between 2018 and 2020 were included. Unadjusted odds ratios (ORs) for postoperative ileus, prolonged LOS, and AKi were plotted against the rate of intraoperative RL infusion (mL/ kg/h) and total intraoperative volume. Binary logistic regression analysis, including fluid volumes as a confounder, was used to identify risk factors for postoperative complications.
A total of 2900 patients were identified. Of them, 503 (17.3%) patients had ileus, 772 (26.6%) patients had prolonged LOS, and 240 (8.3%) patients had AKI. The intraoperative fluid resuscitation rate (mg/kg/h) was less impactful on postoperative ileus, LOS, and AKI than the total amount of intraoperative fluid. A total fluid administration range between 300 mL and 2.7 L was associated with the lowest complication rate. Total intraoperative RL ≥2.7 L was independently associated with a higher risk of ileus (adjusted OR 1.465; 95% confidence interval 1.154-1.858) and prolonged LOS (adjusted OR 1.300; 95% confidence interval 1.047-1.613), but not AKI. Intraoperative RL ≤300 mL was not associated with an increased risk of AKI.
Total intraoperative RL ≥2.7 L was independently associated with postoperative ileus and prolonged LOS in elective colorectal surgery patients. A new potential standard for intraoperative fluids will require anesthesia case planning (complexity and duration) to ensure total fluid volume meets this new opportunity to improve care.
Keywords
Acute Kidney Injury/epidemiology, Acute Kidney Injury/etiology, Female, Fluid Therapy/adverse effects, Humans, Ileus/etiology, Male, Postoperative Complications/epidemiology, Postoperative Complications/etiology, Postoperative Complications/prevention & control, Retrospective Studies, Risk Factors
Pubmed
Web of science
Open Access
Yes
Create date
12/02/2022 15:45
Last modification date
21/05/2022 6:34
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