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Title: The impact of intraoperative and postoperative fluid balance on complications for transthoracic esophagectomy: a retrospective analysis.
Austin Authors: Buchholz, Vered;Hazard, Riley;Yin, Zoe;Tran, Nghiep;Yip, Sui Wah Sean;Le, Peter;Kioussis, Benjamin;Hinton, Jake;Liu, David Shi Hao ;Lee, Dong-Kyu;Weinberg, Laurence 
Affiliation: Surgery (University of Melbourne)
General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Melbourne, Australia.
Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Department of Critical Care, University of Melbourne, Melbourne, Australia.
Issue Date: 6-Nov-2023
Date: 2023
Publication information: BMC Research Notes 2023-11-06; 16(1)
Abstract: Transthoracic esophagectomy is associated with significant morbidity and mortality. Therefore, it is imperative to optimize perioperative management and minimize complications. In this retrospective analysis, we evaluated the association between fluid balance and esophagectomy complications at a tertiary hospital in Melbourne, Australia, with a particular focus on respiratory morbidity and anastomotic leaks. Cumulative fluid balance was calculated intraoperatively, postoperatively in recovery postoperative day (POD) 0, and on POD 1 and 2. High and low fluid balance was defined as greater than or less than the median fluid balance, respectively, and postoperative surgical complications were graded using the Clavien-Dindo classification. In total, 109 patients, with an average age of 64 years, were included in this study. High fluid balance on POD 0, POD1 and POD 2 was associated with a higher incidence of anastomotic leak (OR 8.59; 95%CI: 2.64-39.0). High fluid balance on POD 2 was associated with more severe complications (of any type) (OR 3.33; 95%CI: 1.4-8.26) and severe pulmonary complications (OR 3.04; 95%CI: 1.27-7.67). For every 1 L extra cumulative fluid balance in POD 1, the odds of a major complication increase by 15%, while controlling for body mass index (BMI) and American Society of Anaesthesiologists (ASA) class. The results show that higher cumulative fluid balance is associated with worsening postoperative outcomes in patients undergoing transthoracic esophagectomy. Restricted fluid balance, especially postoperatively, may mitigate the risk of postoperative complications - however prospective trials are required to establish this definitively.
DOI: 10.1186/s13104-023-06574-x
Journal: BMC Research Notes
Start page: 315
PubMed URL: 37932807
ISSN: 1756-0500
Type: Journal Article
Subjects: Anaesthesia
Fluid balance
Esophagectomy/adverse effects
Esophageal Neoplasms/complications
Esophageal Neoplasms/surgery
Anastomotic Leak/surgery
Postoperative Complications/etiology
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