Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2022.06.008
Brazilian Journal of Anesthesiology
Original Investigation

The clinical impact of the systolic volume variation guided intraoperative fluid administration regimen on surgical outcomes after pancreaticoduodenectomy: a retrospective cohort study

O impacto clínico da variação do volume sistólico guiado pelo regime de administração de fluido intraoperatório nos resultados cirúrgicos após pancreaticoduodenectomia: um estudo de coorte retrospectivo

Daniel Negrini, Jacqueline Graaf, Mayan Ihsan, Ana Gabriela Correia, Karine Freitas, Jorge Andre Bravo, Tatiana Linhares, Patrick Barone

Downloads: 0
Views: 109

Abstract

Background
Pancreaticoduodenectomy is associated with high morbidity. Many preoperative variables are risk factors for postoperative complications, but they are primarily non-modifiable. It is not clear whether an intraoperative goal-directed fluid regimen might be associated with fewer postoperative surgical complications compared to current conservative, non-goal-directed fluid practices. We hypothesize that the use of Systolic Volume Variation (SVV)-guided intraoperative fluid administration might be beneficial.

Methods
Data from 223 patients who underwent pancreaticoduodenectomy in our institution between 2015 and 2019 were reviewed. Patients were classified into two groups based on the use of intraoperative use of SVV to guide the administration of fluids. The decision to use SVV or not was made by the attending anesthesiologist. Subjects were classified into SVV-guided intraoperative fluid therapy (SVV group) and non-SVV-guided intraoperative fluid therapy (non-SVV group). Uni and multivariate regression analyses were conducted to determine if SVV-guided fluid therapy was significantly associated with a lower incidence of postoperative surgical complications, such as Postoperative Pancreatic Fistula (POPF), Delayed Gastric Emptying (DGE), among others, after adjusting for confounders.

Results
Baseline, demographic, and intraoperative characteristics were similar between SVV and non-SVV groups. In the multivariate analysis, the use of SVV guidance was significantly associated with fewer postoperative surgical complications (OR = 0.48; 95% CI 0.25–0.91; p = 0.025), even after adjusting for significant covariates, such as perioperative use of epidural, pancreatic gland parenchyma texture, and diameter of the pancreatic duct.

Conclusions
VV-guided intraoperative fluid administration might be associated with fewer postoperative surgical complications after pancreaticoduodenectomy.

Keywords

Fluid therapy;  Patient outcome assessment;  Pancreatico-duodenectomy;  Stroke volume

Resumo

Justificativa: A pancreaticoduodenectomia está associada a alta morbidade. Muitas variáveis pré-operatórias são fatores de risco para complicações pós-operatórias, mas são primariamente não modificáveis. Não está claro se um regime intraoperatório de fluidos direcionado a metas pode estar associado a menos complicações cirúrgicas pós-operatórias em comparação com as práticas atuais conservadoras de fluidos não direcionadas a objetivos. Nossa hipótese é que o uso da administração de fluido intra-operatório guiada pela variação do volume sistólico (VVS) pode ser benéfico. Métodos: Foram revisados dados de 223 pacientes submetidos à pancreaticoduodenectomia em nossa instituição entre 2015 e 2019. Os pacientes foram classificados em dois grupos com base no uso do uso intraoperatório da VVS para orientar a administração de fluidos. A decisão de usar ou não a VVS foi tomada pelo anestesiologista assistente. Os indivíduos foram classificados em fluidoterapia intraoperatória guiada por VVS (grupo VVS) e fluidoterapia intraoperatória não guiada por VVS (grupo não VVS). Análises de regressão uni e multivariada foram realizadas para determinar se a fluidoterapia guiada por VVS estava significativamente associada a uma menor incidência de complicações cirúrgicas pós-operatórias, como fístula pancreática pós-operatória (FPPO), esvaziamento gástrico retardado (EGR), entre outras, após ajuste para fatores de confusão . Resultados: As características basais, demográficas e intraoperatórias foram semelhantes entre os grupos VVS e não VVS. Na análise multivariada, o uso da orientação VVS foi significativamente associado a menos complicações cirúrgicas pós-operatórias (OR = 0,48; IC 95%: 0,25–0,91; p = 0,025), mesmo após ajuste para covariáveis significativas, como uso perioperatório de peridural, textura do parênquima da glândula pancreática e diâmetro do ducto pancreático. Conclusões: A administração intraoperatória de fluidos guiada por VV pode estar associada a menos complicações cirúrgicas pós-operatórias após pancreaticoduodenectomia.

Palavras-chave

Fluidoterapia; Avaliação do resultado do paciente; Pancreaticoduodenectomia; Volume sistólico

References

1 A Pugalenthi, M Protic, M Gonen, et al. Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma J Surg Oncol, 113 (2016), pp. 188-193

2 B Kulemann, M Fritz, T Glatz, et al. Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: a single center retrospective cohort study Ann Med Surg (Lond), 16 (2017), pp. 23-29

3 G Alemanno, C Bergamini, J Martellucci, et al. Surgical outcome of pancreaticoduodenectomy: high volume center or multidisciplinary management? Minerva Chir, 71 (2016), pp. 8-14

4 SJ van Rooijen, D Huisman, M Stuijvenberg, et al. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together Int J Surg, 36 (Pt A) (2016), pp. 183-200

5 PS Myles, R Bellomo, T Corcoran, et al. Restrictive versus liberal fluid therapy for major abdominal surgery N Engl J Med, 378 (2018), pp. 2263-2274

6 P Gill, TC Chua, Y Huang, et al. Pancreatoduodenectomy and the risk of complications from perioperative fluid administration ANZ J Surg, 88 (2018), pp. E318-EE23

7 TJP Batchelor, NJ Rasburn, E Abdelnour-Berchtold, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS) Eur J Cardiothorac Surg, 55 (2019), pp. 91-115

8 PE Marik, R Cavallazzi, T Vasu, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature Crit Care Med, 37 (2009), pp. 2642-2647

9 L Guerin, X Monnet, JL. Teboul Monitoring volume and fluid responsiveness: from static to dynamic indicators Best Pract Res Clin Anaesthesiol, 27 (2013), pp. 177-185

10 C Willars, A Dada, T Hughes, et al. Functional haemodynamic monitoring: the value of SVV as measured by the LiDCORapid™ in predicting fluid responsiveness in high risk vascular surgical patients Int J Surg, 10 (2012), pp. 148-152

11 L Weinberg, D Ianno, L Churilov, et al. Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial PLoS One, 12 (2017) e0183313-e

12 P Téoule, F Bartel, E Birgin, et al. The Clavien-Dindo classification in pancreatic surgery: a clinical and economic validation J Invest Surg, 32 (2019), pp. 314-320

13 WB Pratt, SK Maithel, T Vanounou, et al. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme Ann Surg, 245 (2007), pp. 443-451

14 C Bassi, G Marchegiani, C Dervenis, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After Surgery, 161 (2017), pp. 584-591

15 DJ Kagedan, M Ahmed, KS Devitt, et al. Enhanced recovery after pancreatic surgery: a systematic review of the evidence HPB (Oxford), 17 (2015), pp. 11-16

16 M Sandini, C Fernández-Del Castillo, CR Ferrone, et al. Intraoperative fluid administration and surgical outcomes following pancreaticoduodenectomy: external validation at a tertiary referral center World J Surg, 43 (2019), pp. 929-936

17 M Melis, F Marcon, A Masi, et al. Effect of intra-operative fluid volume on peri-operative outcomes after pancreaticoduodenectomy for pancreatic adenocarcinoma J Surg Oncol, 105 (2012), pp. 81-84

18 BP Chen, M Chen, S Bennett, et al. Systematic review and meta-analysis of restrictive perioperative fluid management in pancreaticoduodenectomy World J Surg, 42 (2018), pp. 2938-2950

19 F Grant, MF Brennan, PJ Allen, et al. Prospective randomized controlled trial of liberal vs restricted perioperative fluid management in patients undergoing pancreatectomy Annals Surg, 264 (2016), pp. 591-598

20 L Gottin, A Martini, N Menestrina, et al. Perioperative fluid administration in pancreatic surgery: a comparison of three regimens J Gastrointest Surg, 24 (2020), pp. 569-577

21 O Belyaev, J Munding, T Herzog, et al. Histomorphological features of the pancreatic remnant as independent risk factors for postoperative pancreatic fistula: a matched-pairs analysis Pancreatology, 11 (2011), pp. 516-524

22 S Crippa, R Salvia, M Falconi, et al. Anastomotic leakage in pancreatic surgery HPB (Oxford), 9 (2007), pp. 8-15

23 A Mathur, HA Pitt, M Marine, et al. Fatty pancreas: a factor in postoperative pancreatic fistula Ann Surg, 246 (2007), pp. 1058-1064

24 G Marchegiani, R Ballarin, G Malleo, et al. Quantitative assessment of pancreatic texture using a durometer: a new tool to predict the risk of developing a postoperative fistula World J Surg, 41 (2017), pp. 2876-2883

25 S Andrianello, G Marchegiani, E Bannone, et al. Clinical implications of intraoperative fluid therapy in pancreatic surgery J Gastrointest Surg, 22 (2018), pp. 2072-2079

26 KC Cummings III, NM Zimmerman, K Maheshwari, et al. Epidural compared with non-epidural analgesia and cardiopulmonary complications after colectomy: a retrospective cohort study of 20,880 patients using a national quality database J Clin Anesth, 47 (2018), pp. 12-18

27 A Joosten, R Hafiane, M Pustetto, et al. Practical impact of a decision support for goal-directed fluid therapy on protocol adherence: a clinical implementation study in patients undergoing major abdominal surgery J Clin Monit Comput, 33 (2019), pp. 15-24

62e419cda953950d3e3702a2 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections