Format

Send to

Choose Destination
BMC Surg. 2017 Jan 13;17(1):6. doi: 10.1186/s12893-016-0203-9.

Postoperative fluid overload is a risk factor for adverse surgical outcome in patients undergoing esophagectomy for esophageal cancer: a retrospective study in 335 patients.

Author information

1
Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany. Torben.Glatz@uniklinik-freiburg.de.
2
Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany.

Abstract

BACKGROUND:

Restrictive intraoperative fluid management is increasingly recommended for patients undergoing esophagectomy. Controversy still exists about the impact of postoperative fluid management on perioperative outcome.

METHODS:

We retrospectively examined 335 patients who had undergone esophagectomy for esophageal cancer at the University Hospital Freiburg between 1996 and 2014 to investigate the relation between intra- and postoperative fluid management and postoperative morbidity after esophagectomy.

RESULTS:

Perioperative morbidity was 75%, the in-hospital mortality 8%. A fluid balance above average on the operation day was strongly associated with a higher rate of postoperative mortality (21% vs 3%, p < 0.001) and morbidity (83% vs 66%, p = 0.001). Univariate analysis for risk factors for adverse surgical outcome (Clavien ≥ III) identified ASA-score (p = 0.002), smoking (p = 0.036), reconstruction by colonic interposition (p = 0.036), cervical anastomosis (p = 0.017), blood transfusion (p = 0.038) and total fluid balance on the operation day and on POD 4 (p = 0.001) as risk factors. Multivariate analysis confirmed only ASA-score (p = 0.001) and total fluid balance (p = 0.001) as independent predictors of adverse surgical outcome.

CONCLUSION:

Intra- and postoperative fluid overload is strongly associated with increased postoperative morbidity. Our results suggest restrictive intra- and especially postoperative fluid management to optimize the outcome after esophagectomy.

KEYWORDS:

Adverse surgical outcome; Esophageal cancer; Esophagectomy; Morbidity; Perioperative fluid management

PMID:
28086855
PMCID:
PMC5237209
DOI:
10.1186/s12893-016-0203-9
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center