Crystalloid Administration Is Associated with the Recovery of Pediatric Elective Roux-en-Y HepaticojejunostomyFunding This study was funded by grants from the National Natural Science Foundation of China (No: 30973440, 30770950) and the key project of the Chongqing Natural Science Foundation (CSTC, 2008BA0021, cstc2012jjA0155).
31 July 2018
13 December 2018
21 January 2019 (eFirst)
Background Intraoperative fluid administration is important for postoperative recovery and might be associated with postoperative complications.
Materials and Methods This retrospective review included 471 patients who underwent Roux-en-Y hepaticojejunostomy. Patients were separated into two groups based on whether they received low (<15.27 mL/kg/h) or high (>15.27 mL/kg/h) volumes of corrected crystalloid fluids. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 192 matched patients, clinical outcomes, including postoperative complications and length of hospital stay, were compared.
Results Higher use of diuresis (p = 0.027) was found in the high fluid group. Receiving low volumes of crystalloids was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.31–1.07; p = 0.047) and first bowel movement (OR, 0.56; 95% CI, 0.38–0.98; p = 0.013). However, the occurrence of renal complications did not show significant differences between the groups. A lower postoperative complication rate (OR, 0.54; 95% CI, 0.42–0.94; p = 0.016) was noted in patients with low crystalloids compared with high crystalloids. The total length of hospital stay was longer in patients with high crystalloid fluid (9.21 ± 3.24 days) than patients with low volumes (7.83 ± 2.58 days; p = 0.012).
Conclusion Low crystalloid fluid administration was associated with favorable postoperative outcomes.
Keywordscrystalloid administration - length of hospital stay - abdominal surgery - acute kidney injury
Xingqin Tan designed and analyzed the data and evaluated the article. Jianxia Liu performed the statistical measurements and analyzed the data. Chunbao Guo analyzed the data and wrote the article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1 Grant F, Brennan MF, Allen PJ. , et al. Prospective randomized controlled trial of liberal vs restricted perioperative fluid management in patients undergoing pancreatectomy. Ann Surg 2016; 264 (04) 591-598
- 2 Kim Y, Ejaz A, Gani F. , et al. Crystalloid administration among patients undergoing liver surgery: defining patient- and provider-level variation. Surgery 2016; 159 (02) 389-398
- 3 de Aguilar-Nascimento JE, Diniz BN, do Carmo AV, Silveira EA, Silva RM. Clinical benefits after the implementation of a protocol of restricted perioperative intravenous crystalloid fluids in major abdominal operations. World J Surg 2009; 33 (05) 925-930
- 4 Benes J, Chytra I, Altmann P. , et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 2010; 14 (03) R118
- 5 Holte K, Klarskov B, Christensen DS. , et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg 2004; 240 (05) 892-899
- 6 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 (05) 767-776
- 7 Kim Y, Gani F, Spolverato G. , et al. Variation in crystalloid administration: an analysis of 6248 patients undergoing major elective surgery. J Surg Res 2016; 203 (02) 368-377
- 8 Desgranges FP, Desebbe O, Pereira de Souza Neto E, Raphael D, Chassard D. Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta-analysis. Paediatr Anaesth 2016; 26 (01) 37-47
- 9 VandeHei MS, Papageorge CM, Murphy MM, Kennedy GD. The effect of perioperative fluid management on postoperative ileus in rectal cancer patients. Surgery 2017; 161 (06) 1628-1632
- 10 Kellum JA, Lameire N. ; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care 2013; 17 (01) 204
- 11 Byon HJ, Lim CW, Lee JH. , et al. Prediction of fluid responsiveness in mechanically ventilated children undergoing neurosurgery. Br J Anaesth 2013; 110 (04) 586-591
- 12 Goren O, Levy A, Cattan A, Lahat G, Matot I. Acute kidney injury in pancreatic surgery; association with urine output and intraoperative fluid administration. Am J Surg 2017; 214 (02) 246-250
- 13 Gan H, Cannesson M, Chandler JR, Ansermino JM. Predicting fluid responsiveness in children: a systematic review. Anesth Analg 2013; 117 (06) 1380-1392
- 14 Cotton BA, Guy JS, Morris Jr JA, Abumrad NN. The cellular, metabolic, and systemic consequences of aggressive fluid resuscitation strategies. Shock 2006; 26 (02) 115-121
- 15 Healy MA, McCahill LE, Chung M. , et al. Intraoperative fluid resuscitation strategies in pancreatectomy: results from 38 hospitals in Michigan. Ann Surg Oncol 2016; 23 (09) 3047-3055
- 16 Smith JW, Matheson PJ, Franklin GA, Harbrecht BG, Richardson JD, Garrison RN. Randomized controlled trial evaluating the efficacy of peritoneal resuscitation in the management of trauma patients undergoing damage control surgery. J Am Coll Surg 2017; 224 (04) 396-404
- 17 Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD. Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Br J Surg 2015; 102 (01) 24-36
- 18 Sen A, Keener CM, Sileanu FE. , et al. Chloride content of fluids used for large-volume resuscitation is associated with reduced survival. Crit Care Med 2017; 45 (02) e146-e153
- 19 Gordon TA, Bowman HM, Bass EB. , et al. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg 1999; 189 (01) 46-56
- 20 Grabitz SD, Farhan HN, Ruscic KJ. , et al. Dose-dependent protective effect of inhalational anesthetics against postoperative respiratory complications: a prospective analysis of data on file from three hospitals in New England. Crit Care Med 2017; 45 (01) e30-e39
- 21 O'Connor ME, Prowle JR. Fluid overload. Crit Care Clin 2015; 31 (04) 803-821
- 22 Song Y, Kwak YL, Song JW, Kim YJ, Shim JK. Respirophasic carotid artery peak velocity variation as a predictor of fluid responsiveness in mechanically ventilated patients with coronary artery disease. Br J Anaesth 2014; 113 (01) 61-66
- 23 Sun Y, Chai F, Pan C, Romeiser JL, Gan TJ. Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery-a systematic review and meta-analysis of randomized controlled trials. Crit Care 2017; 21 (01) 141