The association between high-volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection.

Abstract

Traditional intraoperative fluid administration practices have been challenged this century with data suggesting improved outcomes with restrictive or goal-directed fluid administration during adult bowel surgery. Minimal data on outcomes associated with differing intraoperative fluid administration practice exists for pediatric patients. We assessed factors and outcomes associated with high-volume fluid administration in pediatric patients undergoing colectomy. We hypothesized that high-volume fluid administration is associated with impaired recovery and, thus, increased length of stay. A database of perioperative practice and postoperative outcomes at a tertiary pediatric hospital was queried for colectomy encounters between July 2012 and March 2017. Data extracted included patient characteristics, perioperative clinical data, and postoperative outcomes. Encounters were stratified into two groups: greater than 90th percentile fluids administered (high-volume fluid administration group) vs less than 90th percentile fluids administered. Univariable tests, multivariable logistic regression, and propensity score matched group comparisons were used to asses outcomes associated with high-volume fluid administration. A total of 209 colectomy encounters were identified from which 12 were excluded based on predetermined criteria. High-volume fluid administration was associated with length of stay >6days (AOR 8.14, CI 1.75-37.8, P=0.007), time to first meal >4days (AOR of 5.91, CI 1.30-27.17, P=0.02), and supplemental oxygen requirement >24 hours (AOR 3.60, CI 1.25-10.39, P=0.02) after adjusting for ASA status, blood loss, transfusion, and open surgery. Similarly, propensity score matched patients with high-volume fluid administration vs controls were more likely to have length of stay >6days (93% vs 54%, P=0.007), time to first meal >4days (93% vs 57%, P=0.009), and supplemental oxygen requirement >24 hours (36% vs 12%, P=0.033). High-volume fluid administration during colectomy for pediatric patients is associated with worsened postoperative outcomes suggestive of impaired recovery.