Abstract
BackgroundThe fluid balance associated with a better outcome following emergency surgery is unknown. The aim of this study was to explore the association of the perioperative fluid balance and postoperative complications during emergency gastrointestinal surgery.MethodsWe retrospectively included patients undergoing emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 2.5 L divided the cohort in a conservative and liberal group. Outcome was Clavien-Dindo graded complications registered 90 days postoperatively. We used logistic regression adjusted for age, sex, American Society of Anesthesiologists’ classification, use of epidural analgesia, use of vasopressor, type of surgery, intraabdominal pathology, and hospital. Predicted risk of complications was demonstrated on a continuous scale of the fluid balance.ResultsWe included 342 patients operated between July 2014 and July 2015 from three centers. The perioperative fluid balance was 1.6 L IQR [1.0 to 2.0] in the conservative vs. 3.6 L IQR [3.0 to 5.3] in the liberal group. Odds ratio of overall 2.6 (95% CI 1.5 to 4.4), p < 0.001, and cardiopulmonary complications 3.2 (95% CI 1.9 to 5.7), p < 0.001, were increased in the liberal group. A perioperative fluid balance of 0–2 L was associated with minimal risk of cardiopulmonary complications compared to 1.5–3.5 L for renal complications.ConclusionWe found a perioperative fluid balance above 2.5 L to be associated with an increased risk of overall and cardiopulmonary complications following emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 0–2 L was associated with the lowest risk of cardiopulmonary complications and 1.5–3.5 L for renal complications.
Highlights
Worldwide, more than 310 million patients undergo major surgery each year (Weiser et al, 2015)
We found that a perioperative fluid balance above 2.5 L was significantly associated with an increased risk of overall- and cardiopulmonary complications and that the predicted risk of cardiopulmonary complications was at a minimum at a perioperative fluid balance between 0 and 2 L compared to 1.5– 3.5 L for renal complications
The predicted risk of cardiopulmonary and major complications were at a minimum at a perioperative fluid balance of 0–2 L, whereas the predicted risk of renal complications were at a minimum at a fluid balance of 1.5–3.5 L
Summary
More than 310 million patients undergo major surgery each year (Weiser et al, 2015). Mortality and complication rates are among the highest in patients undergoing emergency gastrointestinal surgery (Khuri et al, 2005; Tengberg et al, 2017). Perioperative intravenous fluid is given to replace fluid loss and to ensure the perfusion of the organs. Escape to the extravascular space rapidly diminishes the circulatory effect. Systemic sepsis and the trauma of surgery might further amplify the extravascular escape of intravenous fluids. Little is known about which fluid strategy that is associated with a better outcome during emergency gastrointestinal surgery. The fluid balance associated with a better outcome following emergency surgery is unknown. The aim of this study was to explore the association of the perioperative fluid balance and postoperative complications during emergency gastrointestinal surgery
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