Effects of 24-hour postoperative intravenous fluid on postoperative outcomes after lobectomy: a retrospective observational study.

Abstract

BackgroundPostoperative fluid management plays a key role in providing adequate tissue perfusion, stabilizing hemodynamics, and reducing morbidities related to hemodynamics. This study evaluated the dose-response relationship between postoperative 24-hour intravenous fluid volume and postoperative outcomes in patients with non-small cell lung cancer (NSCLC) undergoing video-assisted thoracoscopic surgery (VATS) lobectomy.MethodsA retrospective analysis of adult patients with NSCLC undergoing VATS lobectomy between May 2016 and April 2017 was performed. The primary exposure variable was total intravenous crystalloid infusion in the 24-hour postoperative period. The observation outcomes were postoperative pulmonary complications, acute kidney injury (AKI), in-hospital mortality, readmission within 30 days, prolonged hospital stay, postoperative length of stay, and total hospital care costs. Univariate and multivariate analyses were performed.ResultsOf the 563 patients, 136 (24.2%) with pulmonary complications were observed. Binary logistics regression showed that, relative to the group with moderate postoperative 24-hour crystalloid infusion, the risk for postoperative pulmonary complications was significantly increased in the restrictive [odds ratio (OR) 1.815, 95% CI: 1.083–3.043; P=0.024] and liberal (OR 2.692, 95% CI: 1.684–4.305; P<0.001) groups.ConclusionsIn patients with NSCLC undergoing VATS lobectomy, both restrictive and liberal 24-hour postoperative crystalloid infusions were related to adverse effects on postoperative outcomes and the optimal volume of 24-hour postoperative intravenous crystalloid infusion was 1,080–<1,410 mL.