Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Department of Surgery, Grand Rapids, Michigan.
J Surg Oncol. 2014 Sep;110(4):407-11. doi: 10.1002/jso.23662. Epub 2014 May 26.
Given the high incidence of postoperative morbidity following pancreaticoduodenectomy (PD), efforts at improving patient outcomes are vital. We sought to determine the impact of perioperative fluid balance on outcomes following PD in order to identify a targeted strategy for reducing morbidity.
A retrospective review of consecutive PDs from 2008 to 2012 was completed. Cumulative fluid balances were recorded at 0, 24, 48, and 72 hr postoperatively and patients were divided into quartiles. Multivariate analyses were performed accounting for age, gender, diagnosis, ASA class, estimated blood loss, colloid and blood product use, and hemoglobin nadir. The predefined primary outcome measures were 90-day morbidity (Clavien grade ≥ III), mortality, and hospital readmission.
One hundred sixty-nine PDs were performed during the study period. The 90-day morbidity and mortality rates for the cohort were 40.2% and 3.0%, respectively, while hospital length of stay was 13.6 ± 6.7 days (mean ± SD). Higher fluid balance at 48 and 72 hr postoperatively was an independent predictor of morbidity and length of stay on multivariate analysis.
Higher postoperative fluid balance is associated with increased postoperative morbidity and longer hospital stay following PD. Efforts at maintaining a fluid-restrictive strategy should be emphasized in this population.
鉴于胰十二指肠切除术(PD)术后发病率较高,改善患者预后至关重要。我们旨在确定 PD 术后围手术期液体平衡对预后的影响,以确定降低发病率的针对性策略。
对 2008 年至 2012 年连续进行的 PD 进行回顾性研究。记录术后 0、24、48 和 72 小时的累积液体平衡,并将患者分为四分位组。进行多变量分析,考虑年龄、性别、诊断、ASA 分级、估计出血量、胶体和血液制品使用以及血红蛋白最低点。预设的主要结局指标为 90 天发病率(Clavien 分级≥III 级)、死亡率和医院再入院率。
研究期间共进行了 169 例 PD。该队列的 90 天发病率和死亡率分别为 40.2%和 3.0%,住院时间为 13.6±6.7 天(均值±标准差)。术后 48 小时和 72 小时的较高液体平衡是多变量分析中发病率和住院时间的独立预测因素。
术后较高的液体平衡与 PD 术后发病率增加和住院时间延长相关。在该人群中,应强调维持液体限制策略。