School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Department of Surgery, San Gerardo Hospital, Monza, Italy.
Ann Surg. 2019 Nov;270(5):923-929. doi: 10.1097/SLA.0000000000003536.
To evaluate whether perioperative bioimpedance vector analysis (BIVA) predicts the occurrence of surgery-related morbidity.
BIVA is a reliable tool to assess hydration status and compartimentalized fluid distribution.
The BIVA of patients undergoing resection for pancreatic malignancies was prospectively measured on the day prior to surgery and on postoperative day (POD)1. Postoperative morbidity was scored per the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI).
Out of 249 patients, the overall and major complication rates were 61% and 16.5% respectively. The median CCI was 24 (IQR 0.0-24.2), and 24 patients (9.6%) had a complication burden with CCI≥40. At baseline the impedance vectors of severe complicated patients were shorter compared to the vectors of uncomplicated patients only for the female subgroup (P=0.016). The preoperative extracellular water (ECW) was significantly higher in patients who experienced severe morbidity according to the CDC or not [19.4L (17.5-22.0) vs. 18.2L (15.6-20.6), P=0.009, respectively] and CCI≥40, or not [20.3L (18.5-22.7) vs. 18.3L (15.6-20.6), P=0.002, respectively]. The hydration index on POD1 was significantly higher in patients who experienced major complications than in uncomplicated patients (P=0.020 and P=0.025 for CDC and CCI, respectively).At a linear regression model, age (β=0.14, P=0.035), sex female (β=0.40, P<0.001), BMI (β=0.30, P<0.001), and malnutrition (β=0.14, P=0.037) were independent predictors of postoperative ECW.
The amount of extracellular fluid accumulation predicts major morbidity after pancreatic surgery. Female, obese and malnourished patients were at high risk of extracellular fluid accumulation.
评估围手术期生物电阻抗向量分析（BIVA）是否可预测与手术相关的发病率。
BIVA 是一种可靠的工具，可用于评估水合状态和隔室化的液体分布。
前瞻性地测量了 249 例接受胰腺恶性肿瘤切除术的患者在手术前一天和术后第 1 天（POD1）的 BIVA。根据 Clavien-Dindo 分类（CDC）和综合并发症指数（CCI）对术后发病率进行评分。
在 249 例患者中，总并发症和主要并发症发生率分别为 61%和 16.5%。CCI 的中位数为 24（IQR 0.0-24.2），24 例患者（9.6%）的 CCI≥40，并发症负担较重。在基线时，严重并发症患者的阻抗向量比无并发症患者的阻抗向量短，仅在女性亚组中（P=0.016）。根据 CDC 或 CCI 严重程度不同，经历严重发病率的患者术前细胞外液（ECW）明显高于无并发症患者[19.4L（17.5-22.0）比 18.2L（15.6-20.6），P=0.009]，CCI≥40 或不[20.3L（18.5-22.7）比 18.3L（15.6-20.6），P=0.002]。与无并发症患者相比，经历主要并发症的患者在 POD1 的水化指数明显更高（根据 CDC 和 CCI，P=0.020 和 P=0.025）。在线性回归模型中，年龄（β=0.14，P=0.035）、女性（β=0.40，P<0.001）、BMI（β=0.30，P<0.001）和营养不良（β=0.14，P=0.037）是术后 ECW 的独立预测因子。
细胞外液积累量可预测胰腺手术后的主要发病率。女性、肥胖和营养不良的患者有发生细胞外液积累的高风险。
