Jo Jun-Young, Kim Wook-Jong, Choi Dae-Kee, Kim Hyeong Ryul, Lee Eun-Ho, Choi In-Cheol
Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcomes Analysis and Research, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
BMC Surg. 2019 Feb 4;19(1):15. doi: 10.1186/s12893-019-0482-z.
To improve prognosis after esophageal surgery, intraoperative fluid optimization is important. Herein, we hypothesized that hydroxyethyl starch administration during esophagectomy reduce the total amount of fluid infused and it could have a positive effect on postoperative complication occurrence and mortality.
All consecutive adult patients who underwent elective esophageal surgery for cancer were studied. The primary outcome was the development of composite complications including death, cardio-cerebrovascular complications, respiratory complications, renal complications, gastrointestinal complications, sepsis, empyema or abscess, and multi-organ failure. The relationship between perioperative variables and composite complication was evaluated using multivariable logistic regression.
Of 892 patients analyzed, composite complications developed in 271 (30.4%). The higher hydroxyethyl starch ratio in total fluid had a negative relationship with the total fluid infusion amount (r = - 0.256, P < 0.001). In multivariable analysis, intraoperatively administered total fluid per weight per hour (odds ratio, 1.248; 95% CI, 1.153-1.351; P < 0.001) and HES-to-crystalloid ratio (odds ratio, 2.125; 95% CI, 1.521-2.969; P < 0.001) were associated with increased risks of postoperative composite outcomes.
Although hydroxyethyl starch administration reduces the total fluid infusion amount during esophageal surgery for cancer, intravenous hydroxyethyl starch infusion is associated with an increasing risk of postoperative composite complications.
为改善食管手术后的预后，术中液体优化很重要。在此，我们假设在食管切除术中给予羟乙基淀粉可减少液体输注总量，并可能对术后并发症的发生和死亡率产生积极影响。
对所有连续接受择期食管癌手术的成年患者进行研究。主要结局是发生包括死亡、心脑血管并发症、呼吸并发症、肾脏并发症、胃肠道并发症、脓毒症、脓胸或脓肿以及多器官功能衰竭在内的复合并发症。使用多变量逻辑回归评估围手术期变量与复合并发症之间的关系。
在分析的892例患者中，271例（30.4%）发生了复合并发症。总液体中羟乙基淀粉比例越高与总液体输注量呈负相关（r = -0.256，P < 0.001）。在多变量分析中，术中每小时每体重给予的总液体量（比值比，1.248；95%可信区间，1.153 - 1.351；P < 0.001）和羟乙基淀粉与晶体液比例（比值比，2.125；95%可信区间，1.521 - 2.969；P < 0.001）与术后复合结局风险增加相关。
尽管在食管癌手术中给予羟乙基淀粉可减少液体输注总量，但静脉输注羟乙基淀粉与术后复合并发症风险增加相关。
