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01-10-2018 | Original Article

Perioperative Net Fluid Balance Predicts Pancreatic Fistula After Pancreaticoduodenectomy

Authors: Leah K. Winer, Vikrom K. Dhar, Koffi Wima, Tiffany C. Lee, Mackenzie C. Morris, Shimul A. Shah, Syed A. Ahmad, Sameer H. Patel

Published in: Journal of Gastrointestinal Surgery | Issue 10/2018

Abstract

Background

Our goal was to evaluate the relationship between perioperative fluid administration and the development of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD).

Methods

Retrospectively, we analyzed fluid balance over the first 72 h in 104 consecutive patients who underwent PD between 2013 and 2017. Patients were categorized into tertiles (low, medium, and high) by net fluid balance.

Results

POPF was identified in 17.3% of patients (n = 18). No significant demographic differences were identified among tertiles. Similarly, there were no differences in ASA, smoking status, hemoglobin A1C, pathologic findings, operative time, blood loss, intraoperative fluid administration, use of pancreatic stents, use of epidurals, or postoperative lactate. Patients with high 72-h net fluid balance had significantly increased rates of POPF compared with those in the medium and low tertiles (31.4% vs. 11.4% vs. 8.8%, p = 0.02). On multivariate analysis, increasing net fluid balance remained associated with CR-POPF (OR 1.26, CI 1.03–1.55, p = 0.03).

Conclusion

High net 72-h fluid balance is an independent predictor of POPF after PD. Given ongoing efforts to minimize PD morbidity, net fluid balance may represent a clinical predictor and, possibly, a modifiable target for prevention of POPF.

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Title: Perioperative Net Fluid Balance Predicts Pancreatic Fistula After Pancreaticoduodenectomy
Authors: Leah K. Winer
Vikrom K. Dhar
Koffi Wima
Tiffany C. Lee
Mackenzie C. Morris
Shimul A. Shah
Syed A. Ahmad
Sameer H. Patel
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 10/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-3813-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Perioperative Net Fluid Balance Predicts Pancreatic Fistula After Pancreaticoduodenectomy

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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