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Surgical Endoscopy

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01-10-2015

Role of intraoperative fluids on hospital length of stay in laparoscopic bariatric surgery: a retrospective study in 224 consecutive patients

Authors: Vaughn E. Nossaman, William S. Richardson III, James B. Wooldridge Jr., Bobby D. Nossaman

Published in: Surgical Endoscopy | Issue 10/2015

Abstract

Background

Studies are unclear regarding optimal intraoperative fluid management during laparoscopic bariatric surgery. The purpose of this 1-year study was to investigate the role of intraoperative fluid administration on hospital length of stay (hLOS) and postoperative complications in laparoscopic bariatric surgery.

Methods

Patient data analyzed included previously reported demographics, comorbidities, and intraoperative fluid administration on the duration of hLOS and incidence of postoperative complications.

Results

Logistic regression analysis of demographic and comorbidity variables revealed that BMI (P = 0.0099) and history of anemia (P = 0.0084) were significantly associated with hLOS (C index statistic, 0.7). Lower rates of intraoperative fluid administration were significantly associated with longer hLOS (P = 0.0005). Recursive partitioning observed that patients who received <1,750 ml of intraoperative fluids resulted in longer hLOS when compared to patients who received ≥1,750 ml (LogWorth = 0.5). When intraoperative fluid administration rates were defined by current hydration guidelines for major abdominal surgery, restricted rates (<5 ml/kg/h) were associated with the highest incidence of extended hLOS (>1 postoperative day) at 54.1 % when compared to 22.9 % with standard rates (5–7 ml/kg/h) and were lowest at 14.5 % in patients receiving liberal rates (>7 ml/kg/h) (P < 0.0001). Finally, lower rates of intraoperative fluid administration were significantly associated with delayed wound healing (P = 0.03).

Conclusions

The amount of intravenous fluids administered during laparoscopic bariatric surgery plays a significant role on hLOS and on the incidence of delayed wound healing.

Boland MR, Noorani A, Varty K, Coffey JC, Agha R, Walsh SR (2013) Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized, Clinical Trials. World J Surg 37(6):1193–1202. doi:10.1007/s00268-013-1987-8 CrossRefPubMed

Yeager MP, Spence BC (2006) Perioperative fluid management: current consensus and controversies. Semin Dial 19(6):472–479. doi:10.1111/j.1525-139X.2006.00209.x CrossRefPubMed

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. doi:10.1097/01.sla.0000094387.50865.23 PubMedCentralCrossRefPubMed

Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I (2005) Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103(1):25–32CrossRefPubMed

Kita T, Mammoto T, Kishi Y (2002) Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma. J Clin Anesth 14(4):252–256CrossRefPubMed

MacKay G, Fearon K, McConnachie A, Serpell MG, Molloy RG, O’Dwyer PJ (2006) Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery. Br J Surg 93(12):1469–1474. doi:10.1002/bjs.5593 CrossRefPubMed

Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245(6):867–872. doi:10.1097/01.sla.0000259219.08209.36 PubMedCentralCrossRefPubMed

McArdle GT, McAuley DF, McKinley A, Blair P, Hoper M, Harkin DW (2009) Preliminary results of a prospective randomized trial of restrictive versus standard fluid regime in elective open abdominal aortic aneurysm repair. Ann Surg 250(1):28–34. doi:10.1097/SLA.0b013e3181ad61c8 CrossRefPubMed

Futier E, Constantin JM, Petit A, Chanques G, Kwiatkowski F, Flamein R, Slim K, Sapin V, Jaber S, Bazin JE (2010) Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: a prospective randomized trial. Arch Surg 145(12):1193–1200. doi:10.1001/archsurg.2010.275 CrossRefPubMed

10.

Lobo SM, Ronchi LS, Oliveira NE, Brandao PG, Froes A, Cunrath GS, Nishiyama KG, Netinho JG, Lobo FR (2011) Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery. Crit Care 15(5):R226. doi:10.1186/cc10466 PubMedCentralCrossRefPubMed

11.

Hubner M, Schafer M, Demartines N, Muller S, Maurer K, Baulig W, Clavien PA, Zalunardo MP, Zurich Fast Track Study G (2012) Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program. J Surg Res 173(1):68–74. doi:10.1016/j.jss.2010.08.051 CrossRefPubMed

12.

Matot I, Dery E, Bulgov Y, Cohen B, Paz J, Nesher N (2013) Fluid management during video-assisted thoracoscopic surgery for lung resection: a randomized, controlled trial of effects on urinary output and postoperative renal function. J Thorac Cardiovasc Surg 146(2):461–466. doi:10.1016/j.jtcvs.2013.02.015 CrossRefPubMed

13.

Joshi GP (2005) Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg 101(2):601–605. doi:10.1213/01.ANE.0000159171.26521.31 CrossRefPubMed

14.

Doherty M, Buggy DJ (2012) Intraoperative fluids: how much is too much? Br J Anaesth 109(1):69–79. doi:10.1093/bja/aes171 CrossRefPubMed

15.

Lobo DN, Macafee DA, Allison SP (2006) How perioperative fluid balance influences postoperative outcomes. Best Pract Res Clin Anaesthesiol 20(3):439–455CrossRefPubMed

16.

Bundgaard-Nielsen M, Secher NH, Kehlet H (2009) ‘Liberal’ vs. ‘restrictive’ perioperative fluid therapy—a critical assessment of the evidence. Acta Anaesthesiol Scand 53(7):843–851. doi:10.1111/j.1399-6576.2009.02029.x CrossRefPubMed

17.

Thirlby RC (2012) Is my patient wet or dry? Should my patient be wet or dry?: A first step in answering these queries: Comment on “Effect of the volume of fluids administered on intraoperative oliguria in laparoscopic bariatric surgery”. Arch Surg 147(3):234–235. doi:10.1001/archsurg.2011.1413 CrossRefPubMed

18.

Ingrande J, Brodsky JB (2013) Intraoperative fluid management and bariatric surgery. Int Anesthesiol Clin 51(3):80–89. doi:10.1097/AIA.0b013e3182960847 CrossRefPubMed

19.

Matot I, Paskaleva R, Eid L, Cohen K, Khalaileh A, Elazary R, Keidar A (2012) Effect of the volume of fluids administered on intraoperative oliguria in laparoscopic bariatric surgery: a randomized controlled trial. Arch Surg 147(3):228–234. doi:10.1001/archsurg.2011.308 CrossRefPubMed

20.

Jain AK, Dutta A (2010) Stroke volume variation as a guide to fluid administration in morbidly obese patients undergoing laparoscopic bariatric surgery. Obes Surg 20(6):709–715. doi:10.1007/s11695-009-0070-x CrossRefPubMed

21.

Wool DB, Lemmens HJ, Brodsky JB, Solomon H, Chong KP, Morton JM (2010) Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients. Obes Surg 20(6):698–701. doi:10.1007/s11695-010-0092-4 CrossRefPubMed

22.

McGlinch BP, Que FG, Nelson JL, Wrobleski DM, Grant JE, Collazo-Clavell ML (2006) Perioperative care of patients undergoing bariatric surgery. Mayo Clinic Proc Mayo Clinic 81(10 Suppl):S25–S33CrossRef

23.

Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW (2002) Anesthetic considerations for bariatric surgery. Anesth Analg 95(6):1793–1805CrossRefPubMed

24.

Campos GM, Ciovica R, Rogers SJ, Posselt AM, Vittinghoff E, Takata M, Cello JP (2007) Spectrum and risk factors of complications after gastric bypass. Arch Surg 142(10):969–975. doi:10.1001/archsurg.142.10.969 discussion 976CrossRefPubMed

25.

Livingston EH (2005) Complications of bariatric surgery. Surg Clin N Am 85(4):853–868. doi:10.1016/j.suc.2005.04.007 CrossRefPubMed

26.

Livingston EH (2007) Development of bariatric surgery-specific risk assessment tool. Surg Obes Relat Dis 3(1):14–20. doi:10.1016/j.soard.2006.10.009 discussion 20CrossRefPubMed

27.

NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel (1991). Ann Intern Med 115(12):956–961

28.

Brolin RE (1996) Update: NIH consensus conference. Gastrointestinal surgery for severe obesity. Nutrition 12(6):403–404CrossRefPubMed

29.

Strobl C, Malley J, Tutz G (2009) An introduction to recursive partitioning: rationale, application, and characteristics of classification and regression trees, bagging, and random forests. Psychol Methods 14(4):323–348. doi:10.1037/a0016973 PubMedCentralCrossRefPubMed

30.

Marshall RJ (2001) The use of classification and regression trees in clinical epidemiology. J Clin Epidemiol 54(6):603–609CrossRefPubMed

31.

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA, J Am Med Assoc 292(14):1724–1737. doi:10.1001/jama.292.14.1724 CrossRef

32.

Livingston EH (2005) Hospital costs associated with bariatric procedures in the United States. Am J Surg 190(5):816–820. doi:10.1016/j.amjsurg.2005.07.026 CrossRefPubMed

33.

Arkilic CF, Taguchi A, Sharma N, Ratnaraj J, Sessler DI, Read TE, Fleshman JW, Kurz A (2003) Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 133(1):49–55. doi:10.1067/msy.2003.80 CrossRefPubMed

34.

Hosmer DW, Lemeshow S (1999) Applied logistic regression. Wiley, New York

35.

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S, American Association of Clinical E, Obesity S, American Society for Metabolic & Bariatric Surgery (2009) American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity 17(Suppl 1):S1–S70. doi:10.1038/oby.2009.28 PubMed

36.

Stoltzfus JC (2011) Logistic regression: a brief primer. Acad Emerg Med 18(10):1099–1104. doi:10.1111/j.1553-2712.2011.01185.x CrossRefPubMed

Title: Role of intraoperative fluids on hospital length of stay in laparoscopic bariatric surgery: a retrospective study in 224 consecutive patients
Authors: Vaughn E. Nossaman
William S. Richardson III
James B. Wooldridge Jr.
Bobby D. Nossaman
Publication date: 01-10-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-4029-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Role of intraoperative fluids on hospital length of stay in laparoscopic bariatric surgery: a retrospective study in 224 consecutive patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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