Pancreatoduodenectomy and the risk of complications from perioperative fluid administration

Preetjote Gill, Terence C. Chua, Yeqian Huang, Shreya Mehta, Anubhav Mittal, Anthony J. Gill, Jaswinder S. Samra

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The dogma of administering sufficient intravenous fluids aggressively to avoid under-resuscitation has recently been challenged. Evidence suggests that excessive perioperative fluid administration may be associated with negative clinical outcomes in gastrointestinal surgery. This study examines the impact of fluid administration on perioperative outcomes in patients undergoing pancreatoduodenectomy (PD). Methods: A retrospective analysis of 202 patients undergoing PD between January 2004 and August 2015 was performed. A cut-off value of 10mL/kg/h was applied (low fluid group: <10mL/kg/h versus high fluid group: ≥10mL/kg/h). Results: There were 76 patients in the low fluid group and 126 patients in the high fluid group. Both groups had comparable age, American Society of Anesthesiologists score and preoperative morbidity rates. Patients in the high fluid group received significantly more total fluids, crystalloids and colloids intraoperatively (P<0.0001, P<0.0001 and P=0.013, respectively) without a significant difference in estimated blood loss (P=0.586). The net fluid balance on post-operative day 0 was also significantly higher in the high fluid group (P<0.0001). The mortality rate was 0% in the cohort. Major morbidity rate was 46.1% and 44.4% in low and high fluid groups, respectively (P=0.836). Reoperation rate was 5.3% for the low fluid group and 1.6% for the high fluid group (P=0.136). There were no significant differences between the groups for any of the individual complications. Conclusion: This study did not identify a difference in post-operative outcomes between the low and high fluid regime in patients undergoing PD.

LanguageEnglish
PagesE318-E323
Number of pages6
JournalANZ Journal of Surgery
Volume88
Issue number4
Early online date2017
DOIs
Publication statusPublished - Apr 2018

Fingerprint

Pancreaticoduodenectomy
Morbidity
Water-Electrolyte Balance
Colloids
Reoperation
Resuscitation
Mortality

Keywords

  • Complication
  • Fluid
  • Morbidity
  • Pancreatoduodenectomy
  • Perioperative

Cite this

Gill, P., Chua, T. C., Huang, Y., Mehta, S., Mittal, A., Gill, A. J., & Samra, J. S. (2018). Pancreatoduodenectomy and the risk of complications from perioperative fluid administration. ANZ Journal of Surgery, 88(4), E318-E323. https://doi.org/10.1111/ans.13913
Gill, Preetjote ; Chua, Terence C. ; Huang, Yeqian ; Mehta, Shreya ; Mittal, Anubhav ; Gill, Anthony J. ; Samra, Jaswinder S. / Pancreatoduodenectomy and the risk of complications from perioperative fluid administration. In: ANZ Journal of Surgery. 2018 ; Vol. 88, No. 4. pp. E318-E323.
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abstract = "Background: The dogma of administering sufficient intravenous fluids aggressively to avoid under-resuscitation has recently been challenged. Evidence suggests that excessive perioperative fluid administration may be associated with negative clinical outcomes in gastrointestinal surgery. This study examines the impact of fluid administration on perioperative outcomes in patients undergoing pancreatoduodenectomy (PD). Methods: A retrospective analysis of 202 patients undergoing PD between January 2004 and August 2015 was performed. A cut-off value of 10mL/kg/h was applied (low fluid group: <10mL/kg/h versus high fluid group: ≥10mL/kg/h). Results: There were 76 patients in the low fluid group and 126 patients in the high fluid group. Both groups had comparable age, American Society of Anesthesiologists score and preoperative morbidity rates. Patients in the high fluid group received significantly more total fluids, crystalloids and colloids intraoperatively (P<0.0001, P<0.0001 and P=0.013, respectively) without a significant difference in estimated blood loss (P=0.586). The net fluid balance on post-operative day 0 was also significantly higher in the high fluid group (P<0.0001). The mortality rate was 0{\%} in the cohort. Major morbidity rate was 46.1{\%} and 44.4{\%} in low and high fluid groups, respectively (P=0.836). Reoperation rate was 5.3{\%} for the low fluid group and 1.6{\%} for the high fluid group (P=0.136). There were no significant differences between the groups for any of the individual complications. Conclusion: This study did not identify a difference in post-operative outcomes between the low and high fluid regime in patients undergoing PD.",
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Gill, P, Chua, TC, Huang, Y, Mehta, S, Mittal, A, Gill, AJ & Samra, JS 2018, 'Pancreatoduodenectomy and the risk of complications from perioperative fluid administration', ANZ Journal of Surgery, vol. 88, no. 4, pp. E318-E323. https://doi.org/10.1111/ans.13913

Pancreatoduodenectomy and the risk of complications from perioperative fluid administration. / Gill, Preetjote; Chua, Terence C.; Huang, Yeqian; Mehta, Shreya; Mittal, Anubhav; Gill, Anthony J.; Samra, Jaswinder S.

In: ANZ Journal of Surgery, Vol. 88, No. 4, 04.2018, p. E318-E323.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Gill, Preetjote

AU - Chua, Terence C.

AU - Huang, Yeqian

AU - Mehta, Shreya

AU - Mittal, Anubhav

AU - Gill, Anthony J.

AU - Samra, Jaswinder S.

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N2 - Background: The dogma of administering sufficient intravenous fluids aggressively to avoid under-resuscitation has recently been challenged. Evidence suggests that excessive perioperative fluid administration may be associated with negative clinical outcomes in gastrointestinal surgery. This study examines the impact of fluid administration on perioperative outcomes in patients undergoing pancreatoduodenectomy (PD). Methods: A retrospective analysis of 202 patients undergoing PD between January 2004 and August 2015 was performed. A cut-off value of 10mL/kg/h was applied (low fluid group: <10mL/kg/h versus high fluid group: ≥10mL/kg/h). Results: There were 76 patients in the low fluid group and 126 patients in the high fluid group. Both groups had comparable age, American Society of Anesthesiologists score and preoperative morbidity rates. Patients in the high fluid group received significantly more total fluids, crystalloids and colloids intraoperatively (P<0.0001, P<0.0001 and P=0.013, respectively) without a significant difference in estimated blood loss (P=0.586). The net fluid balance on post-operative day 0 was also significantly higher in the high fluid group (P<0.0001). The mortality rate was 0% in the cohort. Major morbidity rate was 46.1% and 44.4% in low and high fluid groups, respectively (P=0.836). Reoperation rate was 5.3% for the low fluid group and 1.6% for the high fluid group (P=0.136). There were no significant differences between the groups for any of the individual complications. Conclusion: This study did not identify a difference in post-operative outcomes between the low and high fluid regime in patients undergoing PD.

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KW - Complication

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