Abstract
BackgroundTo improve prognosis after esophageal surgery, intraoperative fluid optimization is important. Herein, we hypothesized that hydroxyethyl starch administration during esophagectomy reduce the total amount of fluid infused and it could have a positive effect on postoperative complication occurrence and mortality.MethodsAll consecutive adult patients who underwent elective esophageal surgery for cancer were studied. The primary outcome was the development of composite complications including death, cardio-cerebrovascular complications, respiratory complications, renal complications, gastrointestinal complications, sepsis, empyema or abscess, and multi-organ failure. The relationship between perioperative variables and composite complication was evaluated using multivariable logistic regression.ResultsOf 892 patients analyzed, composite complications developed in 271 (30.4%). The higher hydroxyethyl starch ratio in total fluid had a negative relationship with the total fluid infusion amount (r = − 0.256, P < 0.001). In multivariable analysis, intraoperatively administered total fluid per weight per hour (odds ratio, 1.248; 95% CI, 1.153–1.351; P < 0.001) and HES-to-crystalloid ratio (odds ratio, 2.125; 95% CI, 1.521–2.969; P < 0.001) were associated with increased risks of postoperative composite outcomes.ConclusionsAlthough hydroxyethyl starch administration reduces the total fluid infusion amount during esophageal surgery for cancer, intravenous hydroxyethyl starch infusion is associated with an increasing risk of postoperative composite complications.
Highlights
To improve prognosis after esophageal surgery, intraoperative fluid optimization is important
Myocardial infarction Ventricular arrhythmia Mechanical assist device Stroke Respiratory Mechanical ventilation > 48 h Pneumonia Acute lung injury or acute respiratory distress syndrome Renal ≥ KDIGO stage2 Renal replacement therapy Gastrointestinal complications Empyema or abscess Sepsis Multi-organ failure In-hospital death Death within 90 days Composite complications Data are expressed as number of patients (%) KDIGO = Kidney Disease Improving Global Outcomes increasing incidence of composite 90-day major postoperative complications
Of the several approaches suggested for lowering postoperative morbidity and mortality, proper intravenous fluid therapy during esophageal surgery is considered to be an integral part of anesthetic management to reduce postoperative surgical and respiratory complications [16]
Summary
To improve prognosis after esophageal surgery, intraoperative fluid optimization is important. As surgical techniques and perioperative management have improved, overall mortality from esophagectomy has declined to approximately 10%; the morbidity after esophagectomy for esophageal cancer is still approaching to 50% [1,2,3]. To reduce perioperative morbidity and mortality, various trials have been attempted during the past two decades, such as epidural analgesics, minimal invasive techniques, or intraoperative fluid management based on cutting-edge knowledge [5]. In case of esophageal surgery in particular, appropriate perioperative fluid management has a significant role for reducing pulmonary complications, which are regarded as the most important cause of death following esophagectomy [5,6,7].
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