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Gao J, Li L, Gao Z, Ren Y, Wang F, Wang X, Li D, Liu G, Zhang X, Zhang J. Influence of blood loss on cerebral oxygen saturation in paediatric patients undergoing surgery for scoliosis correction: A retrospective observational study. J Paediatr Child Health 2024. [PMID: 39032105 DOI: 10.1111/jpc.16619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/16/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
AIM Surgery for congenital scoliosis correction in children is often associated with considerable blood loss. Decrease in regional oxygen saturation (rScO2) can reflect insufficient cerebral perfusion and predict neurological complications. This retrospective observational study explored the relationship between blood loss during this surgery and a decrease in rScO2 in children. METHODS The following clinical data of children aged 3-14 years who underwent elective posterior scoliosis correction between March 2019 and July 2021 were collected: age, sex, height, weight, baseline rScO2, basal mean invasive arterial pressure (MAP), preoperative Cobb angle, number of surgical segments, preoperative and postoperative haemoglobin level, percentage of lowest rScO2 below the baseline value that lasted 3 min or more during the operation (decline of rScO2 from baseline, D-rScO2%), intraoperative average invasive MAP, end-tidal carbon dioxide pressure, fluid infusion rate of crystalloids and colloids, operation time, and percentage of total blood loss/patient's blood volume (TBL/PBV). RESULTS A total of 105 children were included in the study. Massive haemorrhage (TBL/PBV ≥50%) was reported in 53.3% of patients, who had significantly higher D-rScO2 (%) (t = -5.264, P < 0.001) than those who had non-massive haemorrhage (TBL/PBV <50%). Multiple regression analysis revealed that TBL/PBV (β = 0.04, 95% CI: 0.018-0.062, P < 0.05) was significantly associated with D-rScO2%. CONCLUSIONS Intraoperative massive blood loss in children significantly increased D-rScO2%. Monitoring should be improved, and timely blood supplementation should be performed to ensure maintenance of the blood and oxygen supply to vital organs, improve the safety of anaesthesia, and avoid neurological complications.
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Affiliation(s)
- Jia Gao
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lijing Li
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhengzheng Gao
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yi Ren
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fang Wang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxue Wang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Duoyi Li
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guoliang Liu
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuejun Zhang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jianmin Zhang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Application of a perioperative nursing strategy in the surgical treatment of elderly patients: a narrative review †. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
With the steady increase of older people in society, a progressively greater number of patients belonging to the geriatric group need surgical treatment. Since elderly patients with reduced physiological reserve and organ failure often have chronic diseases, geriatric syndrome, and other clinical problems, the perioperative nursing of elderly patients is more complicated. Therefore, we need to comprehensively consider clinical issues, such as patients’ preoperative status, surgical risks, and postoperative quality of life and life expectancy, and conduct comprehensive evaluations and holistic, individualized, and continuous nursing and therapy through the participation of interdisciplinary teams to achieve better curative effects. Here, the perioperative nursing of elderly patients is reviewed, including preoperative evaluation and nursing, intraoperative management, and postoperative nursing.
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3
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Ripollés-Melchor J, Aldecoa C, Alday-Muñoz E, Del Río S, Batalla A, Del-Cojo-Peces E, Uña-Orejón R, Muñoz-Rodés JL, Lorente JV, Espinosa ÁV, Ferrando-Ortolà C, Jover JL, Abad-Gurumeta A, Ramírez-Rodríguez JM, Abad-Motos A. Intraoperative crystalloid utilization variability and association with postoperative outcomes: A post hoc analysis of two multicenter prospective cohort studies. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN 2021; 68:373-383. [PMID: 34364826 DOI: 10.1016/j.redare.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes. METHODS We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS). RESULTS 7580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval 1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.
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Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
| | - C Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Cuidados Críticos, Hospital Universitario Río Hortega, Valladolid, Spain
| | - E Alday-Muñoz
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario La Princesa, Madrid, Spain
| | - S Del Río
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - A Batalla
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Universitario Sant Pau, Barcelona, Spain
| | - E Del-Cojo-Peces
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Don Benito Vilanueva, Badajoz, Spain
| | - R Uña-Orejón
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Universitario La Paz, Madrid, Spain
| | - J L Muñoz-Rodés
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital General Universitario de Elche, Elche, Spain
| | - J V Lorente
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain
| | - Á V Espinosa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Department of Cardiothoracic and Vascular Anesthesia and Critical Care. MKCC Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain
| | - C Ferrando-Ortolà
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - J L Jover
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Virgen de Los Lirios, Alcoy, Alicante, Spain
| | - A Abad-Gurumeta
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
| | - J M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Cirugía, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - A Abad-Motos
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
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Ripollés-Melchor J, Aldecoa C, Alday-Muñoz E, Del Río S, Batalla A, Del-Cojo-Peces E, Uña-Orejón R, Muñoz-Rodés JL, Lorente JV, Espinosa ÁV, Ferrando-Ortolà C, Jover JL, Abad-Gurumeta A, Ramírez-Rodríguez JM, Abad-Motos A. Intraoperative crystalloid utilization variability and association with postoperative outcomes: A post hoc analysis of two multicenter prospective cohort studies. ACTA ACUST UNITED AC 2021. [PMID: 33752893 DOI: 10.1016/j.redar.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes. METHODS We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS). RESULTS 7,580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.
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Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España.
| | - C Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Cuidados Críticos, Hospital Universitario Río Hortega, Valladolid, España
| | - E Alday-Muñoz
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario de La Princesa, Madrid, España
| | - S Del Río
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - A Batalla
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia, Hospital Universitario Sant Pau, Barcelona, España
| | - E Del-Cojo-Peces
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesia, Hospital Don Benito Villanueva, Badajoz, España
| | - R Uña-Orejón
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesia, Hospital Universitario La Paz, Madrid, España
| | - J L Muñoz-Rodés
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital General Universitario de Elche, Elche, España
| | - J V Lorente
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Juan Ramón Jimenez, Huelva, España
| | - Á V Espinosa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Department of Cardiothoracic and Vascular Anesthesia and Critical Care, MKCC Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Kingdom of Bahrain
| | - C Ferrando-Ortolà
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - J L Jover
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital Virgen de Los Lirios, Alcoy, Alicante, España
| | - A Abad-Gurumeta
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España
| | - J M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Cirugía, Hospital Universitario Lozano Blesa, Zaragoza, España
| | - A Abad-Motos
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España
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D'Souza RS, Sims CR, Andrijasevic N, Stewart TM, Curry TB, Hannon JA, Blackmon S, Cassivi SD, Shen RK, Reisenauer J, Wigle D, Brown MJ. Pulmonary Complications in Esophagectomy Based on Intraoperative Fluid Rate: A Single-Center Study. J Cardiothorac Vasc Anesth 2021; 35:2952-2960. [PMID: 33546968 DOI: 10.1053/j.jvca.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Esophagectomy is associated with significant morbidity and mortality. The authors assessed the relationship between intraoperative fluid (IOF) administration and postoperative pulmonary outcomes in patients undergoing a transthoracic, transhiatal, or tri-incisional esophagectomy. DESIGN Retrospective cohort study (level 3 evidence). SETTING Tertiary care referral center. PARTICIPANTS Patients who underwent esophagectomy from 2007 to 2017. INTERVENTIONS The IOF rate (mL/kg/h) was the predictor variable analyzed both as a continuous and binary categorical variable based on median IOF rate for this cohort (11.90 mL/kg/h). MEASUREMENTS Primary outcomes included rates of acute respiratory distress syndrome (ARDS) within ten days after esophagectomy. Secondary outcomes included rates of reintubation, pneumonia, cardiac or renal morbidity, intensive care unit admission, length of stay, procedure-related complications, and mortality. Multivariate regression analysis determined associations between IOF rate and postoperative outcomes. Analysis was adjusted for age, sex, body mass index, procedure type, year, and thoracic epidural use. MAIN RESULTS A total of 1,040 patients comprised this cohort. Tri-incisional esophagectomy was associated with a higher hospital mortality rate (7.8%) compared with transthoracic esophagectomy (2.6%, p = 0.03) or transhiatal esophagectomy (0.7%, p = 0.01). Regression analysis revealed a higher IOF rate was associated with greater ARDS within ten days (adjusted odds ratio [OR] = 1.03, p = 0.01). For secondary outcomes, a higher IOF rate was associated with greater hospital mortality (adjusted OR = 1.05, p = 0.002), although no significant association with 30-day hospital mortality was identified. CONCLUSIONS Increased IOF administration during esophagectomy may be associated with worse postoperative pulmonary complications, specifically ARDS. Future well-powered studies are warranted, including randomized, controlled trials comparing liberal versus restrictive fluid administration in this surgical population.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Charles R Sims
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Division of Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Nicole Andrijasevic
- Department of Respiratory Therapy, Mayo Clinic, Rochester, MN; Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN
| | - Thomas M Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Timothy B Curry
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - James A Hannon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Robert K Shen
- Department of Thoracic Surgery, Mayo Clinic, Rochester, MN
| | | | - Dennis Wigle
- Department of Thoracic Surgery, Mayo Clinic, Rochester, MN
| | - Michael J Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Grass F, Hübner M, Mathis KL, Hahnloser D, Dozois EJ, Kelley SR, Demartines N, Larson DW. Challenges to accomplish stringent fluid management standards 7 years after enhanced recovery after surgery implementation-The surgeon's perspective. Surgery 2020; 168:313-319. [PMID: 32122658 DOI: 10.1016/j.surg.2020.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to analyze fluid management standards in 2 high-volume, enhanced recovery after surgery institutions 7 years after implementation. METHODS Retrospective analysis of consecutive patients undergoing elective, segmental colonic and extensive colorectal resections for benign and malignant pathology (2011-2017). Administration and composition of intravenous fluids, postoperative weight gain, and factors impeding compliance to preidentified fluid thresholds (3L fluid administration, 2.5 kg weight gain) were assessed. Multivariable logistic regression was performed to identify risk factors for postoperative adverse events. RESULTS A total of 5,155 patients were included. Among them, 2,320 patients (45.1%) received >3 L intravenous fluids at postoperative day 0. Fluid totals remained unchanged over the 7-year observation period. Fluid overload was independently associated with postoperative weight gain ≥2.5 kg at postoperative day 2 (odds ratio 1.34, P < .001). Patients with high American Society of Anesthesiologists score (≥3) undergoing open and longer (≥180 minutes) procedures were more likely to exceed both thresholds according to multivariable analysis (all P < .001). Other than open surgery, American Society of Anesthesiologists score ≥3, contamination class ≥3, and malignancy, both thresholds (≥3 L: odds ratio 1.76, 95% confidence interval 1.44-2.15, ≥ 2.5 kg: odds ratio 1.62, 95% confidence interval 1.33-1.97) were independent risk factors for postoperative adverse outcomes (occurring in 28.1% of patients). CONCLUSION Compliance with fluid thresholds appears to be challenging in patients with comorbidities undergoing open and long procedures. Efforts are encouraged because both thresholds are linked to adverse outcomes and appear to be potentially modifiable in selected patients.
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Affiliation(s)
- Fabian Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN; Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
| | - Dieter Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN.
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Hübner M, Pache B, Solà J, Blanc C, Hahnloser D, Demartines N, Grass F. Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery. BJS Open 2019; 3:532-538. [PMID: 31388646 PMCID: PMC6677103 DOI: 10.1002/bjs5.50166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background Perioperative fluid overload is an important modifiable risk factor for adverse outcomes after colorectal surgery. This study aimed to define critical thresholds for perioperative fluid management and postoperative weight gain for patients undergoing elective laparoscopic colorectal surgery. Methods This was an analysis of consecutive elective laparoscopic colorectal resections at Lausanne University Hospital from May 2011 to May 2017. Main outcomes were overall, major (Clavien–Dindo grade IIIb or above) and respiratory complications, and postoperative ileus. Thresholds regarding perioperative fluid management and postoperative weight gain were identified through receiver operating characteristic (ROC) analysis and clinical judgement. Independent risk factors for all four outcomes were assessed by multinominal logistic regression. Results Overall and major complications occurred in 210 (36·2 per cent) and 46 (7·9 per cent) of 580 patients respectively. Twenty‐three patients (4·0 per cent) had respiratory complications and 98 (16·9 per cent) had postoperative ileus. Median length of hospital stay was 5 (i.q.r. 3–9) days. Based on respiratory complications, thresholds for perioperative intravenous fluid administration (postoperative day (POD) 0) were set pragmatically at 3000 ml for colonic (calculated threshold 3120 ml (area under ROC curve (AUROC) 0·63)) and 4000 ml for rectal (AUROC 0·79) procedures. Postoperative weight gain of 2·5 kg at POD 2 was predictive of respiratory complications. Multivariable analysis retained perioperative intravenous fluid administration over the above thresholds as an independent risk factor for overall (odds ratio (OR) 2·25, 95 per cent c.i. 1·23 to 4·11), major (OR 2·49, 1·17 to 5·31) and respiratory (OR 4·71, 1·42 to 15·58) complications. Weight gain above 2·5 kg at POD 2 was identified as a risk factor for respiratory complications (OR 3·58, 1·10 to 11·70) and ileus (OR 1·82, 1·02 to 3·52). Conclusion Perioperative intravenous fluid and weight thresholds were associated with postoperative adverse outcomes. These thresholds need independent validation.
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Affiliation(s)
- M Hübner
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - B Pache
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - J Solà
- Centre Suisse d'Electronique et de Microtechnique Neuchâtel Switzerland
| | - C Blanc
- Department of Anaesthesiology Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - D Hahnloser
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - N Demartines
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - F Grass
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
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Decreasing the Surgical Stress Response and an Initial Experience from the Enhanced Recovery After Surgery Colorectal Surgery Program at an Academic Institution. Int Anesthesiol Clin 2019; 55:163-178. [PMID: 28901989 DOI: 10.1097/aia.0000000000000162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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9
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Pache B, Hübner M, Solà J, Hahnloser D, Demartines N, Grass F. Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery. Colorectal Dis 2019; 21:234-240. [PMID: 30407708 DOI: 10.1111/codi.14465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/03/2018] [Indexed: 12/12/2022]
Abstract
AIM The present study aimed to analyse fluid management and to define optimal fluid-related thresholds for elective open colorectal surgery. METHOD A retrospective analysis was made of all consecutive elective open colorectal resections performed in our tertiary centre between May 2011 and May 2017. The main outcomes were postoperative complications [overall (I-V) and severe (IIIB-V) according to the Clavien classification], respiratory complications and postoperative ileus (POI). Critical thresholds regarding perioperative fluid management and postoperative weight gain were identified by using receiver operator characteristic (ROC) analysis. Independent risk factors for overall complications were identified by multivariable logistic regression analysis. RESULTS Of 121 patients who had open operations, 84 (69%) had some complication and 26 (21%) had severe complications. Respiratory complications and POI occurred in 15 (12%) and 46 patients (38%), respectively. The thresholds for intravenous fluids were 3.5 l at postoperative day (POD) 0 [area under ROC curve (AUROC) 0.7 for any 0.69 for respiratory complications] and 3.5 kg weight gain at POD 2 (AUROC 0.82 for respiratory complications). Multivariable analysis revealed weight gain of > 3.5 kg at POD 2 (OR 5.9; 95% CI 1.3-16.6) as a significant risk factor for overall complications. Acute kidney injury was observed in five patients (4%), three (5%) in the group with > 3.5 l at POD 0 and two (3%) in the group with < 3.5 l at POD 0 (P = 0.64). Creatinine increase was transitory and all patients regained baseline levels before discharge. CONCLUSION A weight gain of > 3.5 kg at POD 2 has been identified as the critical threshold for overall and respiratory complications and prolonged length of stay after open elective colorectal surgery.
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Affiliation(s)
- B Pache
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - J Solà
- Centre Suisse d'Electronique et de Microtechnique (CSEM), Neuchâtel, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - F Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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