Does perioperative fluid management affect the development of postoperative complications in major gastrointestinal tract surgery? A retrospective cohort study

Year 2022, Volume: 6 Issue: 2, 90 - 93, 01.02.2022

Mehmet Mustafa Altıntaş , Kemal Tolga Saraçoğlu , Aytaç Emre Kocaoğlu , Fırat Mülküt , Ayten Saracoğlu , Selçuk Kaya , Ayhan Çevik

https://doi.org/10.28982/josam.1036062

Abstract

Background/Aim: In major abdominal surgeries, maintenance of electrolyte homeostasis and euvolemia is crucial. However there is still no consensus on the most effective intraoperative fluid regimen. Our primary aim in this study was to investigate the impact of colloid infusion given in addition to perioperative fluid replacement on the development of postoperative complications in patients undergoing major gastrointestinal tract surgery.
Methods: Patients who underwent major abdominal surgery in our hospital due to gastrointestinal tract malignancy between January 2015 and January 2020 were enrolled in this retrospective cohort study. We recorded data regarding the volume of perioperative fluid replacement, the amount of crystalloid and colloid administered, postoperative complications, length of hospital stay, frequency of follow-up in the intensive care unit and length of stay.
Results: A total of 326 patients, who underwent gastrointestinal tract surgery, were included in the study. Postoperative pulmonary complications (24.2%), wound infection (20.6%), and anastomotic leakage (3.1%) were the most-observed three complications in the study cohort. Among 163 patients who required postoperative ICU follow-up, 84 (25.7%) patients received colloid infusion, whereas 79 (24.2%) patients did not receive (P=0.181). However, the incidence of other complications in the group with a crystalloid intake of ≤2 L was found to be significantly higher compared to the group receiving >2 L of crystalloids (P=0.038).
Conclusion: We found no association between the administration of colloids along with crystalloid infusion and the incidence of postoperative complications. Besides there was no relation with the adverse effects in terms of the length of hospital stay and the frequency of admission to the intensive care unit.

Keywords

Crystalloid, Colloid, Surgery, Fluid replacement

References

• 1. Myburgh JA, Mythen MG. Resuscitationfluids. N Engl J Med. 2013;369(13):1243–51.doi: 10.1056/NEJMra1208627.
• 2. Joosten A, Coeckelenbergh S, Alexander B, Delaporte A, Cannesson M, Duranteau J, et al. Hydroxyethylstarch for perioperative goal-directed fluid therapy in 2020: a narrative review. BMC Anesthesiol. 2020 Aug 20;20(1):209. doi: 10.1186/s12871-020-01128-1.
• 3. Joosten A, Delaporte A, Ickx B, Touihri K, Stany I, Barvais L, et al. Crystalloidversuscolloidforintraoperativegoal-directedfluidtherapy using a closed-loop system: arandomized, double-blinded, controlled trial in major abdominal surgery.Anesthesiology. 2018;128(1):55-66.doi: 10.1097/ALN.0000000000001936.
• 4. Van Der Linden P, James M, Mythen M, Weiskopf RB. Safety of modern starches used during surgery. Anesth Analg. 2013;116(1):35-48.doi: 10.1213/ANE.0b013e31827175da.
• 5. Johansen JR, Perner A, Brodtkorb JH, Møller MH. Use of hydroxyethyl starch in sepsis research: A systematic review with meta-analysis. Acta Anaesthesiol Scand. 2021;65(10):1355-64.doi: 10.1111/aas.13954.
• 6. Nagore D, Candela A, Bürge M, Monedero P, Tamayo E, Alvarez J, et al; Spanish Perioperative Cardiac Surgery Research Group. Hydroxyethylstarchandacutekidneyinjury in high-risk patients undergoing cardiacsurgery: A prospective multicenter study. J Clin Anesth. 2021;73:110367. doi: 10.1016/j.jclinane.2021.110367.
• 7. Heringlake M, Berggreen AE, Reemts E, Schemke S, Balzer F, Charitos EI, et al. Fluid Therapy With Gelatin May Have Deleterious Effects on Kidney Function: An Observational Trial. J Cardiothorac Vasc Anesth. 2020;34(10):2674-81. doi: 10.1053/j.jvca.2020.03.037.
• 8. Sevcikova S, Durila M, Vymazal T. Rotational thromboelastometry assessment of balanced crystalloid, hydroxyethyl starch and gelatin effects on coagulation: a randomized trial. Braz J Anesthesiol. 2019;69(4):383-9. Portuguese. doi: 10.1016/j.bjan.2019.03.009.
• 9. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018;378(24):2263-74. doi: 10.1056/NEJMoa1801601.
• 10. Saracoglu KT, Eti Z, Ugurlu U, Orhon M, Gogus FY. The effects of preoperative fluid administration on postoperative acid-base and electrolyte balance in patients undergoing total gastrectomy. Anestezi Derg. 2014;22(1):18-24.
• 11. Myles P, Bellomo R, Corcoran T, Forbes A, Wallace S, Peyton P, et al. Australian and New Zealand College of Anaesthetists Clinical Trials Network, and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multi centre randomized trial. BMJ Open. 2017;7(3):e015358. doi: 10.1136/bmjopen-2016-015358.
• 12. Miller TE, Myles PS. Perioperative Fluid Therapy for Major Surgery. Anesthesiology. 2019;130(5):825-32. doi: 10.1097/ALN.0000000000002603.
• 13. Reiterer C, Kabon B, Zotti O, Obradovic M, Kurz A, Fleischmann E. Effect of goal-directed crystalloid- versus colloid-based fluid strategy on tissue oxygen tension: a randomized controlled trial. Br J Anaesth. 2019;123(6):768-76. doi: 10.1016/j.bja.2019.08.027.
• 14. Lilot M, Ehrenfeld JM, Lee C, Harrington B, Cannesson M, Rinehart J. Variability in practice and factors predictive of total crystalloid administration during abdominal surgery: retrospective two-centre analysis. Br J Anaesth. 2015;114(5):767-76. doi: 10.1093/bja/aeu452.
• 15. Kim Y, Gani F, Spolverato G, Ejaz A, Xu L, Buettner S, et al. Variation in crystalloid administration: an analysis of 6248 patients undergoing major elective surgery. J SurgRes. 2016;203(2):368-77. doi: 10.1016/j.jss.2016.02.045.
• 16. Jung DM, Ahn HJ, Yang M, Kim JA, Kim DK, Lee SM, et al. Hydroxyethyl starch is associated with early postoperative delirium in patients undergoing esophagectomy. J Thorac Cardiovasc Surg. 2018;155(3):1333-43. doi: 10.1016/j.jtcvs.2017.10.077.
• 17. Gratz J, Zotti O, Pausch A, Wiegele M, Fleischmann E, Gruenberger T, et al. Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial. J ClinMed. 2021;10(8):1651. doi: 10.3390/jcm10081651.
• 18. Kang D, Yoo KY. Fluid management in perioperative and critically ill patients. Acute Crit Care. 2019;34(4):235-45. doi: 10.4266/acc.2019.00717.