Back to 2025 Abstracts
FIRST 48: ASSOCIATION OF EXCESS PERIOPERATIVE INTRAVENOUS FLUIDS AND OPIOID ADMINISTRATION ON COMPLICATIONS AFTER PANCREATECTOMY
Brittany C. Fields
*, Adriana C. Gamboa, Jessica E. Maxwell, Zhouxuan Li, Laura R. Prakash, Morgan L. Bruno, Elsa M. Arvide, Whitney L. Dewhurst, Naruhiko Ikoma, Rebecca A. Snyder, Michael P. Kim, Jose Soliz, Matthew Katz, Ching-Wei D. Tzeng
The University of Texas MD Anderson Cancer Center, Houston, TX
Introduction While improved clinical outcomes are observed with use of risk-stratified pancreatectomy clinical pathways (RSPCP) with guidelines such as early oral intake and timely transition to oral opioids, excess intravenous fluids (IVF) and oral morphine equivalents (OME) in the early perioperative period may be associated with negative sequelae. This study assesses the association of IVF and OME administered in the first 48 hours of pancreatectomy care (postoperative day [POD]0-POD2 at 7AM) with 90-day complication severity.
MethodsPerioperative data for pancreatectomies performed 10/2016-03/2024, were abstracted from the medical record and a prospectively maintained database. Cohorts were defined per pathway as low-risk pancreatoduodenectomy (PD), high-risk PD, distal pancreatectomy (DP), or no pathway (e.g., combined cases). Major complications were defined as ACCORDION ?3. Reported median (interquartile range) served as the cutoff for IVF and OME in the regression model used to analyze the effect of variables of interest.
ResultsOf 1180 consecutive patients, there were 37% (437) low-risk PD, 22% (259) high-risk PD, 30% (350) DP, and 11% (134) no pathway. Most (81%, 950/1180) were performed via open approach, and 25% (291/1180) had major complications (low-risk PD 21% [93/437]; high-risk PD 39% [100/259]; DP 17% [58/350]; no pathway 30% [40/134]; p<0.001). Median case duration was 6.8 (5.0-8.2) hours, longest for low-risk PD (7.8 [6.8-8.9] hours, p<0.001), who also received the most intraoperative IVF (2.3 [1.8-3.0] liters, p<0.001). Median overall intraoperative IVF volume was 2.0 (1.5-2.7) liters. All patients received regional blocks. Intraoperative OME (24.5 [21.0-42.5] mg) did not differ among cohorts.
On POD1-POD2, high-risk PD patients received the most IVF (POD1 2.2 [1.8-2.6] liters, p<0.001; POD2 0.6 [0.4-0.7] liters, p<0.001) and opioids (POD1 (56.7 [32.3-86.7] mg, p<0.001; POD2 (15.0 [6.0-30.0] mg, p<0.001) among all cohorts. Cumulative first 48-hour OME was also greatest for high-risk PD (82.8 [43.0-124.4] mg), primarily from intravenous patient-controlled analgesia (74.0 of 82.8 [38.0-119.5] mg, p<0.001).
Greater complication severity was associated with higher volumes of first 48-hour IVF and OME (Figure 1). On multivariable logistic regression, major complication risk was associated with first 48-hour OME ?86 mg (OR 1.43, 95%CI 1.06-1.93, p=0.021) and IVF ?7.4 liters (OR 1.95, 95%CI 1.43-2.65, p<0.001), with a 15% increased risk per liter of IVF (OR 1.15, 95%CI 1.08-1.22, p<0.001).
ConclusionRisk-stratified clinical pathways for low-risk pancreatoduodenectomy and distal pancreatectomy are associated with less perioperative OME and IVF in the first 48 hours. Intentional limits on first 48-hour IVF and OME may potentially help lower major complication risk, particularly in patients at higher risk of developing pancreatic fistulas.
Back to 2025 Abstracts
