Abstract
BackgroundTransthoracic esophagectomy, among the most invasive surgeries, is highly associated with postoperative infectious complications which adversely affect postoperative management including fluid dynamics. The aim of the study is to evaluate the utility of perioperative bioelectrical impedance analysis (BIA) measurements for the patients after transthoracic esophagectomy.MethodMulti-frequency BIA measurements were conducted in 24 patients undergoing transthoracic esophagectomy preoperatively, at 1 h after surgery, and twice daily for the following 7 days. The amounts of extracellular water (ECW), internal cellular water (ICW), total body water (TBW), and fat-free mass (FFM) were calculated. Changing trends in variables were analyzed, and the patients were subdivided according to the presence of infectious surgical adverse events to identify differences in fluid dynamics.ResultsECW was the major body fluid compartment showing an increase after surgery, and peaked on postoperative day (POD) 2. Twelve patients experienced infectious complications. The peaks of changes in ECW and ECW/TBW appeared earlier and their values at the highest peak were significantly lower in the group without infectious complications on POD 2. The ICW/FFM value showed a mild decrease as compared to POD1 and then gradually recovered. It was significantly lower even before surgery and showed the most significant stratification on POD2. ECW/TBW of 48% and ICW/FFM of 37% on POD2 were predictive cut-off values for infectious adverse events with high area-under receiver operating characteristic (ROC) curves: 0.80 or higher.ConclusionBIA measurements are useful for monitoring fluid retention and may predict infectious complications in the early phase after transthoracic esophagectomy.Trial registrationRegistry name: UMIN-CTR, ID: UMIN000030734, Registered on January 9, 2018, retrospectively registered.
Highlights
Transthoracic esophagectomy, among the most invasive surgeries, is highly associated with postoperative infectious complications which adversely affect postoperative management including fluid dynamics
extracellular water (ECW) was the major body fluid compartment showing an increase after surgery, and peaked on postoperative day (POD) 2
bioelectrical impedance analysis (BIA) measurements are useful for monitoring fluid retention and may predict infectious complications in the early phase after transthoracic esophagectomy
Summary
Transthoracic esophagectomy, among the most invasive surgeries, is highly associated with postoperative infectious complications which adversely affect postoperative management including fluid dynamics. Understanding the fluid dynamics modulated by surgical stress is essential to managing perioperative patients. As the patient recovers from surgical stress, the body fluids in the interstitial compartment begin to redistribute into the intravascular compartment, i.e. fluid retention manifests. This postoperative event generally occurs within a few days and the extent of fluid dynamic changes reflects the invasiveness of the surgical procedure. It is mandatory, especially in patients who have undergone invasive surgery, to carefully manage the infusion volume especially during the fluid redistribution phase. Preventing fluid overload as well as the resultant burden on the respiratory and cardiovascular systems is essential to avoiding a variety of postoperative adverse events
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
