Nossaman Vaughn E, Richardson William S, Wooldridge James B, Nossaman Bobby D
Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.
Department of Surgery, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA.
Surg Endosc. 2015 Oct;29(10):2960-9. doi: 10.1007/s00464-014-4029-1. Epub 2014 Dec 17.
Studies are unclear regarding optimal intraoperative fluid management during laparoscopic bariatric surgery. The purpose of this 1-year study was to investigate the role of intraoperative fluid administration on hospital length of stay (hLOS) and postoperative complications in laparoscopic bariatric surgery.
Patient data analyzed included previously reported demographics, comorbidities, and intraoperative fluid administration on the duration of hLOS and incidence of postoperative complications.
Logistic regression analysis of demographic and comorbidity variables revealed that BMI (P = 0.0099) and history of anemia (P = 0.0084) were significantly associated with hLOS (C index statistic, 0.7). Lower rates of intraoperative fluid administration were significantly associated with longer hLOS (P = 0.0005). Recursive partitioning observed that patients who received <1,750 ml of intraoperative fluids resulted in longer hLOS when compared to patients who received ≥ 1,750 ml (LogWorth = 0.5). When intraoperative fluid administration rates were defined by current hydration guidelines for major abdominal surgery, restricted rates (<5 ml/kg/h) were associated with the highest incidence of extended hLOS (>1 postoperative day) at 54.1 % when compared to 22.9 % with standard rates (5-7 ml/kg/h) and were lowest at 14.5 % in patients receiving liberal rates (>7 ml/kg/h) (P < 0.0001). Finally, lower rates of intraoperative fluid administration were significantly associated with delayed wound healing (P = 0.03).
The amount of intravenous fluids administered during laparoscopic bariatric surgery plays a significant role on hLOS and on the incidence of delayed wound healing.
关于腹腔镜减肥手术期间最佳术中液体管理的研究尚不明确。这项为期1年的研究旨在探讨术中液体输注对腹腔镜减肥手术住院时间（hLOS）和术后并发症的作用。
分析的患者数据包括先前报告的人口统计学、合并症以及术中液体输注对hLOS持续时间和术后并发症发生率的影响。
对人口统计学和合并症变量的逻辑回归分析显示，BMI（P = 0.0099）和贫血病史（P = 0.0084）与hLOS显著相关（C指数统计量，0.7）。术中液体输注率较低与较长的hLOS显著相关（P = 0.0005）。递归划分观察到，与接受≥1750 ml术中液体的患者相比，接受<1750 ml术中液体的患者hLOS更长（LogWorth = 0.5）。当根据当前腹部大手术的液体复苏指南定义术中液体输注率时，限制率（<5 ml/kg/h）与延长hLOS（术后>1天）的最高发生率相关，为54.1%，而标准率（5 - 7 ml/kg/h）为22.9%，接受宽松率（>7 ml/kg/h）的患者最低，为14.5%（P < 0.0001）。最后，术中液体输注率较低与伤口愈合延迟显著相关（P = 0.03）。
腹腔镜减肥手术期间静脉输注的液体量对hLOS和伤口愈合延迟的发生率有显著影响。
