Eng Oliver S, Arlow Renee L, Moore Dirk, Chen Chunxia, Langenfeld John E, August David A, Carpizo Darren R
Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903.
Department of Biostatistics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.
J Surg Res. 2016 Jan;200(1):91-7. doi: 10.1016/j.jss.2015.07.021. Epub 2015 Jul 16.
Esophagectomy is associated with significant morbidity. Optimizing perioperative fluid administration is one potential strategy to mitigate morbidity. We sought to investigate the relationship of intraoperative fluid (IOF) administration to outcomes in patients undergoing transhiatal esophagectomy with particular attention to malnourished patients, who may be more susceptible to the effects of fluid overload.
Patients who underwent transhiatal esophagectomy from 2000-2013 were identified from a retrospective database. IOF rates (mL/kg/hr) were determined and their relationship to outcomes compared. To examine the impact of malnutrition, we stratified patients based on median preoperative serum albumin and compared outcomes.
211 patients comprised the cohort. 74% of patients underwent esophagectomy for esophageal adenocarcinoma. Linear regression analyses were performed comparing independent perioperative variables to four outcomes variables: length of stay, complications per patient, major complications, and Clavien-Dindo classification. IOF rate was significantly associated with three of four outcomes on univariate analysis. Significantly more patients with a preoperative albumin level ≤3.7 g/dL who received more than the median IOF rate experienced more severe complications.
Increased intraoperative fluid administration is associated with perioperative morbidity in patients undergoing transhiatal esophagectomy. Patients with lower preoperative albumin levels may be particularly sensitive to the effects of volume overload.
食管切除术与显著的发病率相关。优化围手术期液体管理是减轻发病率的一种潜在策略。我们试图研究术中液体（IOF）输注与经裂孔食管切除术患者预后的关系，尤其关注营养不良患者，他们可能更容易受到液体超负荷影响。
从回顾性数据库中识别出2000年至2013年接受经裂孔食管切除术的患者。确定IOF率（毫升/千克/小时）并比较其与预后的关系。为了研究营养不良的影响，我们根据术前血清白蛋白中位数对患者进行分层并比较预后。
该队列包括211名患者。74%的患者因食管腺癌接受食管切除术。进行线性回归分析，将围手术期独立变量与四个预后变量进行比较：住院时间、每位患者的并发症、严重并发症和Clavien-Dindo分类。单因素分析显示，IOF率与四个预后中的三个显著相关。术前白蛋白水平≤3.7 g/dL且接受超过中位数IOF率的患者发生更严重并发症的比例显著更高。
术中液体输注增加与经裂孔食管切除术患者的围手术期发病率相关。术前白蛋白水平较低的患者可能对容量超负荷的影响特别敏感。
