Fluid administration and morbidity in transhiatal esophagectomy.
Fluid administration and morbidity in transhiatal esophagectomy.
复制标题
经裂孔食管切除术中的液体管理和发病率。
DOI：
10.1016/j.jss.2015.07.021
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Carpizo,DarrenR
中科院分区：
文献类型：
--
作者：
Eng,OliverS;Arlow,ReneeL;Moore,Dirk;Chen,Chunxia;Langenfeld,JohnE;August,DavidA;Carpizo,DarrenR
背景食道切除术与显著的发病率相关。优化围手术期液体管理是一个潜在的策略，以减轻发病率。我们试图研究术中液体（IOF）给药与经食管切除术患者预后的关系，特别关注营养不良的患者，他们可能更容易受到液体过载的影响。材料和方法从回顾性数据库中确定2000-2013年接受经食管切除术的患者。测定IOF率（mL/kg/hr）并比较其与预后的关系。为了检查营养不良的影响，我们根据中位术前血清白蛋白对患者进行分层并比较结果。结果与讨论211例患者组成队列。74%的食管腺癌患者行食管切除术。将独立围手术期变量与四个结果变量进行线性回归分析：住院时间、每位患者并发症、主要并发症和Clavien-Dindo分类。在单变量分析中，IOF率与四个结果中的三个结果显著相关。术前白蛋白水平≤3.7 g/dL且IOF率高于中位数的患者出现更严重的并发症。结论术中液体给药增加与经食管切除术患者围术期发病率相关。术前白蛋白水平较低的患者可能对容量过载的影响特别敏感。
BackgroundEsophagectomy is associated with significant morbidity. Optimizing perioperative fluid administration is one potential strategy to mitigate morbidity. We sought to investigate the relationship of intraoperative fluid (IOF) administration to outcomes in patients undergoing transhiatal esophagectomy with particular attention to malnourished patients, who may be more susceptible to the effects of fluid overload.Material and methodsPatients who underwent transhiatal esophagectomy from 2000-2013 were identified from a retrospective database. IOF rates (mL/kg/hr) were determined and their relationship to outcomes compared. To examine the impact of malnutrition, we stratified patients based on median preoperative serum albumin and compared outcomes.Results and discussion211 patients comprised the cohort. 74% of patients underwent esophagectomy for esophageal adenocarcinoma. Linear regression analyses were performed comparing independent perioperative variables to four outcomes variables: length of stay, complications per patient, major complications, and Clavien-Dindo classification. IOF rate was significantly associated with three of four outcomes on univariate analysis. Significantly more patients with a preoperative albumin level ≤3.7 g/dL who received more than the median IOF rate experienced more severe complications.ConclusionsIncreased intraoperative fluid administration is associated with perioperative morbidity in patients undergoing transhiatal esophagectomy. Patients with lower preoperative albumin levels may be particularly sensitive to the effects of volume overload.