TY - JOUR
T1 - Effects of Intraoperative Fluid Management on Postoperative Outcomes
T2 - A Hospital Registry Study
AU - Shin, Christina H.
AU - Long, Dustin R.
AU - McLean, Duncan
AU - Grabitz, Stephanie D.
AU - Ladha, Karim
AU - Timm, Fanny P.
AU - Thevathasan, Tharusan
AU - Pieretti, Alberto
AU - Ferrone, Cristina
AU - Hoeft, Andreas
AU - Scheeren, Thomas W.L.
AU - Thompson, Boyd Taylor
AU - Kurth, Tobias
AU - Eikermann, Matthias
N1 - Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Objective: Evaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. Background: Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols driven by such measures are limited in their ability to define the optimal fluid state during surgery. Methods: This analysis of data on file included 92,094 adult patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014 at an academic tertiary care hospital and two affiliated community hospitals. The primary exposure variable was total intraoperative volume of crystalloid and colloid administered. The primary outcome was 30-day survival. Secondary outcomes were respiratory complications within three postoperative days (pulmonary edema, reintubation, pneumonia, or respiratory failure) and acute kidney injury. Exploratory outcomes were postoperative length of stay and total cost of care. Our models were adjusted for patient-, procedure-, and anesthesia-related factors. Results: A U-shaped association was observed between the volume of fluid administered intraoperatively and 30-day mortality, costs, and postoperative length of stay. Liberal fluid volumes (highest quintile of fluid administration practice) were significantly associated with respiratory complications whereas both liberal and restrictive (lowest quintile) volumes were significantly associated with acute kidney injury. Moderately restrictive volumes (second quintile) were consistently associated with optimal postoperative outcomes and were characterized by volumes approximately 40% less than traditional textbook estimates: infusion rates of approximately 6-7mL/kg/hr or 1 L of fluid for a 3-hour case. Conclusions: Intraoperative fluid dosing at the liberal and restrictive margins of observed practice is associated with increased morbidity, mortality, cost, and length of stay.
AB - Objective: Evaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. Background: Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols driven by such measures are limited in their ability to define the optimal fluid state during surgery. Methods: This analysis of data on file included 92,094 adult patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014 at an academic tertiary care hospital and two affiliated community hospitals. The primary exposure variable was total intraoperative volume of crystalloid and colloid administered. The primary outcome was 30-day survival. Secondary outcomes were respiratory complications within three postoperative days (pulmonary edema, reintubation, pneumonia, or respiratory failure) and acute kidney injury. Exploratory outcomes were postoperative length of stay and total cost of care. Our models were adjusted for patient-, procedure-, and anesthesia-related factors. Results: A U-shaped association was observed between the volume of fluid administered intraoperatively and 30-day mortality, costs, and postoperative length of stay. Liberal fluid volumes (highest quintile of fluid administration practice) were significantly associated with respiratory complications whereas both liberal and restrictive (lowest quintile) volumes were significantly associated with acute kidney injury. Moderately restrictive volumes (second quintile) were consistently associated with optimal postoperative outcomes and were characterized by volumes approximately 40% less than traditional textbook estimates: infusion rates of approximately 6-7mL/kg/hr or 1 L of fluid for a 3-hour case. Conclusions: Intraoperative fluid dosing at the liberal and restrictive margins of observed practice is associated with increased morbidity, mortality, cost, and length of stay.
KW - acute kidney injury
KW - cost
KW - healthcare utilization
KW - intraoperative fluid management
KW - length of stay
KW - mortality
KW - outcomes
KW - postoperative respiratory complications
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U2 - 10.1097/SLA.0000000000002220
DO - 10.1097/SLA.0000000000002220
M3 - Article
C2 - 28288059
AN - SCOPUS:85015078563
SN - 0003-4932
VL - 267
SP - 1084
EP - 1092
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -