Fluid management for critical patients undergoing urgent colectomy.

Details

Serval ID
serval:BIB_60966BE17026
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Fluid management for critical patients undergoing urgent colectomy.
Journal
Journal of evaluation in clinical practice
Author(s)
Grass F., Pache B., Butti F., Solà J., Hahnloser D., Demartines N., Hübner M.
ISSN
1365-2753 (Electronic)
ISSN-L
1356-1294
Publication state
Published
Issued date
02/2020
Peer-reviewed
Oui
Volume
26
Number
1
Pages
109-114
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The present study aimed to define thresholds for perioperative fluids and weight gain after urgent colectomies.
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.
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 was identified (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).
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.
Keywords
fluid management, postoperative complications, postoperative morbidity, urgent colectomy, weight gain
Pubmed
Create date
24/06/2019 17:02
Last modification date
24/01/2020 6:19
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