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Ratio of Intraoperative Fluid to Anesthesia Time and Its Impact on Short Term Perioperative Outcomes Following Gastrectomy for Cancer
Laura Enomoto*1, Aaron Blackham2, Yanghee Woo3, Maki Yamamoto2, Jose Pimiento2, Niraj J. Gusani1, Joyce Wong1
1Surgery, Penn State Hershey Medical Center, Hershey, PA; 2Moffitt Cancer Center, Tampa, FL; 3Columbia University Medical Center, New York, NY
Introduction. A restricted approach to intraoperative fluid administration has been reported to be beneficial in certain types of surgery, including thoracic and pancreatic surgery. This study aims to evaluate the short-term impact of fluid administration following gastrectomy for cancer.
Methods. A multi-institutional database of patients undergoing gastrectomy for cancer from three tertiary centers was reviewed. Demographic and perioperative data from 1997- 2014 was included. Logistic and generalized linear regression analyses were performed.
Results. 205 patients were included. The median age was 67.2 years, with a slight male predominance (N=111, 54%). Nearly 66% (N=136) of the cohort was overweight or obese (body mass index ≥25). The median ASA class was 3. The majority of patients (N=116, 57%) underwent resection for proximal disease. Median anesthesia time was 247 minutes (range 95-691 minutes). Median intraoperative crystalloid administration was 2901 ml (range 500 - 10,700 ml). Median colloid administration was 0 (range 0 - 3835ml), although only 66 patients (32%) received colloid. 56 (27%) developed complications post-operatively, with 20 (10%) developing a Clavien-Dindo grade ≥3 complication. Median length of stay (LOS) was 8 days (range 4-51). The majority (N=185, 90%) was discharged home; however, 17 (8%) were discharged to a rehabilitation or nursing facility. On multivariate analysis, controlling for BMI, blood loss, and other demographic and perioperative factors, a significantly higher risk of complications was found in patients who received ≤9.0 ml of crystalloid per minute of anesthesia (N=56, 27%) vs. 9.1-11.0 ml, N=32, 16%, (OR 6.44, p=0.04); increased complications was not found with >11.0 ml (N=110, 54%) of crystalloid/minute anesthesia. In analysis of total fluid (crystalloid and colloid) received, those who received <10.0 ml per minute of anesthesia (N=59, 29%) had a significantly higher risk of complications vs. greater than 10.0 ml, N=138, 67%, (OR 4.25, p=0.01). Colloid administration and transfusion of packed red blood cells were not independently associated with development of complications. The crystalloid and total fluid administration ratio did not significantly affect LOS. However, presence of a post-operative complication increased LOS by 3.5 days (p=0.001); proximal disease was also associated with increased LOS. Crystalloid administration, total fluid administration, and post-operative complications did not affect discharge location.
Conclusions. A restrictive approach to intraoperative fluid administration appears to be associated with an increased risk of complications; this study identified an ideal ratio of 10 ml total fluid volume/minute anesthesia. This ratio, however, did not independently impact LOS or discharge location; further study is needed to determine whether this may affect long-term outcomes.
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