Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2014

Open Access 01-12-2014 | Research article

Impact of intraoperative fluid administration on outcome in patients undergoing robotic-assisted laparoscopic prostatectomy – a retrospective analysis

Authors: Tobias Piegeler, Pamela Dreessen, Sereina M Graber, Sarah R Haile, Daniel Max Schmid, Beatrice Beck-Schimmer

Published in: BMC Anesthesiology | Issue 1/2014

Login to get access

Abstract

Background

Robotic-assisted laparoscopic prostatectomy (RALP) gained much popularity during the last decade. Although the influence of intraoperative fluid management on patients’ outcome has been largely discussed in general, its impact on perioperative complications and length of hospitalization in patients undergoing RALP has not been examined so far. We hypothesized that a more restrictive fluid management might lead to a shortened length of hospitalization and a decreased rate of complications in our patients.

Methods

Retrospective analysis of data of 182 patients undergoing RALP at an University Hospital (first series of RALP performed at the center).

Results

The amount of fluid administered was initially normalized for body mass index of the patient and the duration of the operation and additionally corrected for age and the interaction of these variables. The application of crystalloids (multiple linear regression model, estimate = -0.044, p = 0.734) had no effect on the length of hospitalization, whereas a negative effect was found for colloids (estimate = -8.317, p = 0.021). Additionally, a significant interaction term between age and the amount of colloid applied (estimate = 0.129, p = 0.028) was calculated. Evaluation of the influence of intraoperative fluid administration using multiple logistic regression models corrected for body mass index, duration of the surgery and additionally for age revealed a negative effect of crystalloids on the incidence of an anastomotic leak between bladder and urethra (estimate = -23.860, p = 0.017), with a significant interaction term between age and the amount of crystalloids (estimate = 0.396, p = 0.0134). Colloids had no significant effect on this particular complication (estimate = 1.887, p = 0.524). Intraoperative blood loss did not alter the incidence of an anastomotic leak (estimate = 0.001, p = 0.086), nor did it affect the length of hospitalization (estimate = 0.0001, p = 0.351).

Conclusions

In accordance to the findings of our study, we suggest that a standardized, more restrictive fluid management might be beneficial in patients undergoing RALP. In older patients this measure would be able to shorten the length of hospitalization and to decrease the incidence of anastomosis leakage as a major complication.
Appendix
Available only for authorised users
Literature
1.
Abbou CC, Hoznek A, Salomon L, Olsson LE, Lobontiu A, Saint F, Cicco A, Antiphon P, Chopin D: Laparoscopic radical prostatectomy with a remote controlled robot. J Urol. 2001, 165 (6 Pt 1): 1964-1966.CrossRefPubMed
2.
3.
Badani KK, Kaul S, Menon M: Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007, 110 (9): 1951-1958.CrossRefPubMed
4.
Carlsson S, Nilsson AE, Schumacher MC, Jonsson MN, Volz DS, Steineck G, Wiklund PN: Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010, 75 (5): 1092-1097.CrossRefPubMed
5.
Jeong J, Choi EY, Kim IY: Clavien classification of complications after the initial series of robot-assisted radical prostatectomy: the Cancer Institute of New Jersey/Robert Wood Johnson Medical School experience. J Endourol. 2010, 24 (9): 1457-1461.CrossRefPubMed
6.
Phong SV, Koh LK: Anaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position. Anaesth Intensive Care. 2007, 35 (2): 281-285.PubMed
7.
Kalmar AF, Foubert L, Hendrickx JF, Mottrie A, Absalom A, Mortier EP, Struys MM: Influence of steep Trendelenburg position and CO (2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010, 104 (4): 433-439.CrossRefPubMed
8.
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 Therapy: Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003, 238 (5): 641-648.CrossRefPubMedPubMedCentral
9.
Kimberger O, Arnberger M, Brandt S, Plock J, Sigurdsson GH, Kurz A, Hiltebrand L: Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon. Anesthesiology. 2009, 110 (3): 496-504.CrossRefPubMed
10.
Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I: Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005, 103 (1): 25-32.CrossRefPubMed
11.
Moretti EW, Robertson KM, El-Moalem H, Gan TJ: Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration. Anesth Analg. 2003, 96 (2): 611-617. table of contentsPubMed
12.
Bundgaard-Nielsen M, Secher NH, Kehlet H: ‘Liberal’ vs. ‘restrictive’ perioperative fluid therapy--a critical assessment of the evidence. Acta Anaesthesiol Scand. 2009, 53 (7): 843-851.CrossRefPubMed
13.
MacKay G, Fearon K, McConnachie A, Serpell MG, Molloy RG, O’Dwyer PJ: Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery. Br J Surg. 2006, 93 (12): 1469-1474.CrossRefPubMed
14.
Doherty M, Buggy DJ: Intraoperative fluids: how much is too much?. Br J Anaesth. 2012, 109 (1): 69-79.CrossRefPubMed
15.
R Development Core Team: R: A Language and Environment for Statistical Computing. 2009, Vienna: R Foundation for Statistical Computing
16.
Jacob M, Chappell D, Rehm M: The ‘third space’–fact or fiction?. Best Pract Res Clin Anaesthesiol. 2009, 23 (2): 145-157.CrossRefPubMed
17.
Marjanovic G, Villain C, Juettner E, zur Hausen A, Hoeppner J, Hopt UT, Drognitz O, Obermaier R: Impact of different crystalloid volume regimes on intestinal anastomotic stability. Ann Surg. 2009, 249 (2): 181-185.CrossRefPubMed
18.
Marjanovic G, Villain C, Timme S, Zur Hausen A, Hoeppner J, Makowiec F, Holzner P, Hopt UT, Obermaier R: Colloid vs. crystalloid infusions in gastrointestinal surgery and their different impact on the healing of intestinal anastomoses. Int J Colorectal Dis. 2010, 25 (4): 491-498.CrossRefPubMed
19.
Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO, Michard F: Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care. 2007, 11 (5): R100-CrossRefPubMedPubMedCentral
20.
Holte K, Klarskov B, Christensen DS, Lund C, Nielsen KG, Bie P, Kehlet H: Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg. 2004, 240 (5): 892-899.CrossRefPubMedPubMedCentral
21.
Holte K, Foss NB, Andersen J, Valentiner L, Lund C, Bie P, Kehlet H: Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anaesth. 2007, 99 (4): 500-508.CrossRefPubMed
22.
Gainsburg DM, Wax D, Reich DL, Carlucci JR, Samadi DB: Intraoperative management of robotic-assisted versus open radical prostatectomy. JSLS. 2010, 14 (1): 1-5.CrossRefPubMedPubMedCentral
23.
Danic MJ, Chow M, Alexander G, Bhandari A, Menon M, Brown M: Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robotic Surg. 2007, 1 (2): 119-123.CrossRef
24.
Ou YC, Yang CR, Wang J, Cheng CL, Patel VR: Learning curve of robotic-assisted radical prostatectomy with 60 initial cases by a single surgeon. Asian J Surg. 2011, 34 (2): 74-80.CrossRefPubMed
25.
Ou YC, Yang CR, Wang J, Yang CK, Cheng CL, Patel VR, Tewari AK: The learning curve for reducing complications of robotic-assisted laparoscopic radical prostatectomy by a single surgeon. BJU Int. 2011, 108 (3): 420-425.CrossRefPubMed
26.
Sharma NL, Papadopoulos A, Lee D, McLoughlin J, Vowler SL, Baumert H, Warren AY, Patil V, Shah N, Neal DE: First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. BJU Int. 2011, 108 (5): 739-747.PubMed
27.
Gregori A, Simonato A, Lissiani A, Bozzola A, Galli S, Gaboardi F: Laparoscopic radical prostatectomy: perioperative complications in an initial and consecutive series of 80 cases. Eur Urol. 2003, 44 (2): 190-194.CrossRefPubMed
28.
Apfel CC, Kranke P, Eberhart LH: Comparison of surgical site and patient’s history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia. 2004, 59 (11): 1078-1082.CrossRefPubMed
29.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004, 240 (2): 205-213.CrossRefPubMedPubMedCentral
Metadata
Title
Impact of intraoperative fluid administration on outcome in patients undergoing robotic-assisted laparoscopic prostatectomy – a retrospective analysis
Authors
Tobias Piegeler
Pamela Dreessen
Sereina M Graber
Sarah R Haile
Daniel Max Schmid
Beatrice Beck-Schimmer
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2014
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-14-61

Other articles of this Issue 1/2014

BMC Anesthesiology 1/2014 Go to the issue

Research article

Tissue ischemia microdialysis assessments following severe traumatic haemorrhagic shock: lactate/pyruvate ratio as a new resuscitation end point?

Research article

Extubation force depends upon angle of force application and fixation technique: a study of 7 methods

Research article

Intrathecal injection of fluorocitric acid inhibits the activation of glial cells causing reduced mirror pain in rats

Research article

Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation

Research article

Association between red blood cell storage duration and clinical outcome in patients undergoing off-pump coronary artery bypass surgery: a retrospective study

Research article

The combination of MELD score and ICG liver testing predicts length of stay in the ICU and hospital mortality in liver transplant recipients