Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery.

Details

Serval ID
serval:BIB_F5876A19BD1F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery.
Journal
Colorectal disease
Author(s)
Pache B., Hübner M., Solà J., Hahnloser D., Demartines N., Grass F.
ISSN
1463-1318 (Electronic)
ISSN-L
1462-8910
Publication state
Published
Issued date
02/2019
Peer-reviewed
Oui
Volume
21
Number
2
Pages
234-240
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The present study aimed to analyse fluid management and to define optimal fluid-related thresholds for elective open colorectal surgery.
A retrospective analysis was made of all consecutive elective open colorectal resections performed in our tertiary centre between May 2011 and May 2017. The main outcomes were postoperative complications [overall (I-V) and severe (IIIB-V) according to the Clavien classification], respiratory complications and postoperative ileus (POI). Critical thresholds regarding perioperative fluid management and postoperative weight gain were identified by using receiver operator characteristic (ROC) analysis. Independent risk factors for overall complications were identified by multivariable logistic regression analysis.
Of 121 patients who had open operations, 84 (69%) had some complication and 26 (21%) had severe complications. Respiratory complications and POI occurred in 15 (12%) and 46 patients (38%), respectively. The thresholds for intravenous fluids were 3.5 l at postoperative day (POD) 0 [area under ROC curve (AUROC) 0.7 for any 0.69 for respiratory complications] and 3.5 kg weight gain at POD 2 (AUROC 0.82 for respiratory complications). Multivariable analysis revealed weight gain of > 3.5 kg at POD 2 (OR 5.9; 95% CI 1.3-16.6) as a significant risk factor for overall complications. Acute kidney injury was observed in five patients (4%), three (5%) in the group with > 3.5 l at POD 0 and two (3%) in the group with < 3.5 l at POD 0 (P = 0.64). Creatinine increase was transitory and all patients regained baseline levels before discharge.
A weight gain of > 3.5 kg at POD 2 has been identified as the critical threshold for overall and respiratory complications and prolonged length of stay after open elective colorectal surgery.
Keywords
Aged, Colorectal Surgery, Elective Surgical Procedures, Female, Fluid Therapy/standards, Humans, Length of Stay/statistics & numerical data, Male, Middle Aged, Postoperative Complications/prevention & control, ROC Curve, Retrospective Studies, Risk Factors, Weight Gain, Open colectomy, fluid management, ileus, postoperative complications, postoperative morbidity, weight gain
Pubmed
Web of science
Create date
13/11/2018 13:20
Last modification date
27/04/2020 6:20
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