Challenges to accomplish stringent fluid management standards 7 years after enhanced recovery after surgery implementation-The surgeon's perspective.

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Version: Final published version
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Serval ID
serval:BIB_E1390FD53590
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Challenges to accomplish stringent fluid management standards 7 years after enhanced recovery after surgery implementation-The surgeon's perspective.
Journal
Surgery
Author(s)
Grass F., Hübner M., Mathis K.L., Hahnloser D., Dozois E.J., Kelley S.R., Demartines N., Larson D.W.
ISSN
1532-7361 (Electronic)
ISSN-L
0039-6060
Publication state
Published
Issued date
08/2020
Peer-reviewed
Oui
Volume
168
Number
2
Pages
313-319
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
This study aimed to analyze fluid management standards in 2 high-volume, enhanced recovery after surgery institutions 7 years after implementation.
Retrospective analysis of consecutive patients undergoing elective, segmental colonic and extensive colorectal resections for benign and malignant pathology (2011-2017). Administration and composition of intravenous fluids, postoperative weight gain, and factors impeding compliance to preidentified fluid thresholds (3L fluid administration, 2.5 kg weight gain) were assessed. Multivariable logistic regression was performed to identify risk factors for postoperative adverse events.
A total of 5,155 patients were included. Among them, 2,320 patients (45.1%) received >3 L intravenous fluids at postoperative day 0. Fluid totals remained unchanged over the 7-year observation period. Fluid overload was independently associated with postoperative weight gain ≥2.5 kg at postoperative day 2 (odds ratio 1.34, P < .001). Patients with high American Society of Anesthesiologists score (≥3) undergoing open and longer (≥180 minutes) procedures were more likely to exceed both thresholds according to multivariable analysis (all P < .001). Other than open surgery, American Society of Anesthesiologists score ≥3, contamination class ≥3, and malignancy, both thresholds (≥3 L: odds ratio 1.76, 95% confidence interval 1.44-2.15, ≥ 2.5 kg: odds ratio 1.62, 95% confidence interval 1.33-1.97) were independent risk factors for postoperative adverse outcomes (occurring in 28.1% of patients).
Compliance with fluid thresholds appears to be challenging in patients with comorbidities undergoing open and long procedures. Efforts are encouraged because both thresholds are linked to adverse outcomes and appear to be potentially modifiable in selected patients.
Pubmed
Web of science
Open Access
Yes
Create date
05/03/2020 15:14
Last modification date
22/01/2022 7:12
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