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Langenbeck's Archives of Surgery

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Open Access 01-12-2020 | Original Article

Correlation of postoperative fluid balance and weight and their impact on outcomes

Authors: Fabio Butti, Basile Pache, Michael Winiker, Fabian Grass, Nicolas Demartines, Martin Hübner

Published in: Langenbeck's Archives of Surgery | Issue 8/2020

Abstract

Introduction

Normovolemia after major surgery is critical to avoid complications. The aim of the present study was to analyze correlation between fluid balance, weight gain, and postoperative outcomes.

Methods

All consecutive patients undergoing elective or emergency major abdominal surgery needing intermediate care unit (IMC) admission from September 2017 to January 2018 were included. Postoperative fluid balances and daily weight changes were calculated for postoperative days (PODs) 0–3. Risk factors for postoperative complications (30-day Clavien) and prolonged length of IMC and hospital stay were identified through uni- and multinominal logistic regression.

Results

One hundred eleven patients were included, of which 55% stayed in IMC beyond POD 1. Overall, 67% experienced any complication, while 30% presented a major complication (Clavien ≥ III). For the entire cohort, median cumulative fluid balance at the end of PODs 0–1–2–3 was 1850 (IQR 1020–2540) mL, 2890 (IQR 1610–4000) mL, 3890 (IQR 2570–5380) mL, and 4000 (IQR 1890–5760) mL respectively, and median weight gain was 2.2 (IQR 0.3–4.3) kg, 3 (1.5–4.7) kg, and 3.9 (2.5–5.4) kg, respectively. Fluid balance and weight course showed no significant correlation (r = 0.214, p = 0.19). Extent of surgery, analyzed through Δ albumin and duration of surgery, significantly correlated with POD 2 fluid balances (p = 0.04, p = 0.006, respectively), as did POD 3 weight gain (p = 0.042). Prolonged IMC stay of ≥ 3 days was related to weight gain ≥ 3 kg at POD 2 (OR 2.8, 95% CI 1.01–8.9, p = 0.049).

Conclusion

Fluid balance and weight course showed only modest correlation. POD 2 weight may represent an easy and pragmatic tool to optimize fluid management and help to prevent fluid-related postoperative complications.

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Acheampong A, Vincent JL (2015) A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care 19:251. https://doi.org/10.1186/s13054-015-0970-1CrossRefPubMedPubMedCentral

Bouchard J, Mehta RL (2009) Fluid accumulation and acute kidney injury: consequence or cause. Curr Opin Crit Care 15(6):509–513. https://doi.org/10.1097/MCC.0b013e328332f653CrossRefPubMed

Sakr Y, Vincent JL, Reinhart K, Groeneveld J, Michalopoulos A, Sprung CL, Artigas A, Ranieri VM, Sepsis Occurence in Acutely Ill Patients I (2005) High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest 128(5):3098–3108. https://doi.org/10.1378/chest.128.5.3098CrossRefPubMed

Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen PE, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F, Danish Study Group on Perioperative Fluid T (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238(5):641–648. https://doi.org/10.1097/01.sla.0000094387.50865.23CrossRefPubMedPubMedCentral

de Almeida JP, Palomba H, Galas FR, Fukushima JT, Duarte FA, Nagaoka D, Torres V, Yu L, Vincent JL, Auler JO Jr, Hajjar LA (2012) Positive fluid balance is associated with reduced survival in critically ill patients with cancer. Acta Anaesthesiol Scand 56(6):712–717. https://doi.org/10.1111/j.1399-6576.2012.02717.xCrossRefPubMed

Grass F, Pache B, Butti F, Sola J, Hahnloser D, Demartines N, Hubner M (2019) Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure. Langenbeck's Arch Surg 404(1):39–43. https://doi.org/10.1007/s00423-018-1744-4CrossRef

Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O (2019) Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations: 2018. World J Surg 43(3):659–695. https://doi.org/10.1007/s00268-018-4844-yCrossRefPubMed

Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schafer M, Parks RW, Fearon KC, Lobo DN, Demartines N, Braga M, Ljungqvist O, Dejong CH, Enhanced Recovery After Surgery Society fPC, European Society for Clinical N, Metabolism, International Association for Surgical M, Nutrition (2013) Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. World J Surg 37(2):240–258. https://doi.org/10.1007/s00268-012-1771-1CrossRefPubMed

Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, Law S, Lindblad M, Maynard N, Neal J, Pramesh CS, Scott M, Mark Smithers B, Addor V, Ljungqvist O (2019) Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 43(2):299–330. https://doi.org/10.1007/s00268-018-4786-4CrossRef

10.

Melloul E, Hubner M, Scott M, Snowden C, Prentis J, Dejong CH, Garden OJ, Farges O, Kokudo N, Vauthey JN, Clavien PA, Demartines N (2016) Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 40(10):2425–2440. https://doi.org/10.1007/s00268-016-3700-1CrossRefPubMed

11.

Mortensen K, Nilsson M, Slim K, Schafer M, Mariette C, Braga M, Carli F, Demartines N, Griffin SM, Lassen K, Enhanced Recovery After Surgery G (2014) Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Br J Surg 101(10):1209–1229. https://doi.org/10.1002/bjs.9582CrossRefPubMed

12.

Group EC (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261(6):1153–1159. https://doi.org/10.1097/SLA.0000000000001029CrossRef

13.

Daffurn K, Hillman KM, Bauman A, Lum M, Crispin C, Ince L (1994) Fluid balance charts: do they measure up? Br J Nurs 3(16):816–820CrossRef

14.

Ozuna LA, Adkins AT (1993) Development of a vital-sign/fluid-balance flow sheet. Oncol Nurs Forum 20(1):113–115PubMed

15.

Pflaum SS (1979) Investigation of intake-output as a means of assessing body fluid balance. Heart Lung 8(3):495–498PubMed

16.

Koster M, Dennhardt S, Juttner F, Hopf HB (2017) Cumulative changes in weight but not fluid volume balances reflect fluid accumulation in ICU patients. Acta Anaesthesiol Scand 61(2):205–215. https://doi.org/10.1111/aas.12840CrossRefPubMed

17.

Tolstrup J, Brandstrup B (2015) Clinical assessment of fluid balance is incomplete for colorectal surgical patients. Scand J Surg 104(3):161–168. https://doi.org/10.1177/1457496914543978CrossRefPubMed

18.

Raghunathan K, Singh M, Lobo DN (2015) Fluid management in abdominal surgery: what, when, and when not to administer. Anesthesiol Clin 33(1):51–64. https://doi.org/10.1016/j.anclin.2014.11.004CrossRefPubMed

19.

Labgaa I, Joliat GR, Kefleyesus A, Mantziari S, Schafer M, Demartines N, Hubner M (2017) Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European Centre. BMJ Open 7(4):e013966. https://doi.org/10.1136/bmjopen-2016-013966CrossRefPubMedPubMedCentral

20.

Norberg A, Rooyackers O, Segersvard R, Wernerman J (2016) Leakage of albumin in major abdominal surgery. Crit Care 20(1):113. https://doi.org/10.1186/s13054-016-1283-8CrossRefPubMedPubMedCentral

21.

Sonoda A, Ohnishi S, Nakao S, Iwashita Y, Hashimoto N, Ishida K, Kondo Y, Ishitsuka Y, Irie T (2015) Factors affecting serum albumin in the perioperative period of colorectal surgery: a retrospective study. BMC Res Notes 8:638. https://doi.org/10.1186/s13104-015-1632-8CrossRefPubMedPubMedCentral

22.

Regenbogen SE, Shah NJ, Collins SD, Hendren S, Englesbe MJ, Campbell DA Jr (2017) Population-based assessment of intraoperative fluid administration practices across three surgical specialties. Ann Surg 265(5):930–940. https://doi.org/10.1097/SLA.0000000000001745CrossRefPubMedPubMedCentral

23.

Gupta R, Gan TJ (2016) Peri-operative fluid management to enhance recovery. Anaesthesia 71(Suppl 1):40–45. https://doi.org/10.1111/anae.13309CrossRefPubMed

24.

Scott MJ, Baldini G, Fearon KC, Feldheiser A, Feldman LS, Gan TJ, Ljungqvist O, Lobo DN, Rockall TA, Schricker T, Carli F (2015) Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand 59(10):1212–1231. https://doi.org/10.1111/aas.12601CrossRefPubMedPubMedCentral

25.

Thiele RH, Raghunathan K, Brudney CS, Lobo DN, Martin D, Senagore A, Cannesson M, Gan TJ, Mythen MM, Shaw AD, Miller TE, Perioperative Quality Initiative IW (2016) American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioper Med (Lond) 5:24. https://doi.org/10.1186/s13741-016-0049-9CrossRef

26.

Thiele RH, Raghunathan K, Brudney CS, Lobo DN, Martin D, Senagore A, Cannesson M, Gan TJ, Mythen MMG, Shaw AD, Miller TE, Perioperative Quality Initiative IW (2018) Correction to: American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioper Med (Lond) 7:5. https://doi.org/10.1186/s13741-018-0085-8CrossRef

27.

Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, Gan TJ, Kennedy RH, Ljungqvist O, Lobo DN, Miller T, Radtke FF, Ruiz Garces T, Schricker T, Scott MJ, Thacker JK, Ytrebo LM, Carli F (2016) Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 60(3):289–334. https://doi.org/10.1111/aas.12651CrossRefPubMed

28.

Hubner M, Pache B, Sola J, Blanc C, Hahnloser D, Demartines N, Grass F (2019) Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery. BJS Open 3(4):532–538. https://doi.org/10.1002/bjs5.50166CrossRefPubMedPubMedCentral

29.

Pache B, Hubner M, Sola J, Hahnloser D, Demartines N, Grass F (2019) Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery. Color Dis 21(2):234–240. https://doi.org/10.1111/codi.14465CrossRef

30.

Grass F, Crippa J, Lovely JK, Ansell J, Behm KT, Achilli P, Hubner M, Kelley SR, Mathis KL, Dozois EJ, Larson DW (2020) Readmissions within 48 hours of discharge: reasons, risk factors, and potential improvements. Dis Colon Rectum 63(8):1142–1150. https://doi.org/10.1097/DCR.0000000000001652CrossRefPubMed

31.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef

32.

Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258(1):1–7. https://doi.org/10.1097/SLA.0b013e318296c732CrossRefPubMed

33.

Perren A, Markmann M, Merlani G, Marone C, Merlani P (2011) Fluid balance in critically ill patients. Should we really rely on it? Minerva Anestesiol 77(8):802–811PubMed

34.

Mantziari S, Hubner M, Coti-Bertrand P, Pralong F, Demartines N, Schafer M (2015) A novel approach to major surgery: tracking its pathophysiologic footprints. World J Surg 39(11):2641–2651. https://doi.org/10.1007/s00268-015-3181-7CrossRefPubMed

35.

Desborough JP (2000) The stress response to trauma and surgery. Br J Anaesth 85(1):109–117. https://doi.org/10.1093/bja/85.1.109CrossRefPubMed

36.

Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152(3):292–298. https://doi.org/10.1001/jamasurg.2016.4952CrossRefPubMed

37.

Weinberg L, Wong D, Karalapillai D, Pearce B, Tan CO, Tay S, Christophi C, McNicol L, Nikfarjam M (2014) The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenectomy (Whipple’s procedure). BMC Anesthesiol 14:35. https://doi.org/10.1186/1471-2253-14-35CrossRefPubMedPubMedCentral

Title: Correlation of postoperative fluid balance and weight and their impact on outcomes
Authors: Fabio Butti
Basile Pache
Michael Winiker
Fabian Grass
Nicolas Demartines
Martin Hübner
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-02004-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Correlation of postoperative fluid balance and weight and their impact on outcomes

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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