Raphael Shamavonian1,2, Rohan McLachlan1,3,4, Oliver M Fisher1,2, Sarah J Valle1, Nayef A Alzahrani1,3,5, Winston Liauw3,6, David L Morris1,3. 1. Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia. 2. School of Medicine, University of Notre Dame, Sydney, NSW, Australia. 3. St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia. 4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. 5. College of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. 6. Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia.
Abstract
BACKGROUND: Determine the effect of intraoperative fluids (IOFs) administered during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on postoperative patient outcomes. METHODS: Retrospective cohort study of patients that underwent CRS/HIPEC from February 2010 to June 2017. RESULTS: A total of 335 patients formed the cohort study. Patients who received higher IOFs had longer hospital length of stay (LOS) (34 vs. 22.5 days; P<0.001), extended intensive care unit (ICU) admission (5.3 vs. 3.2 days; P<0.001) and a 12% increase in grade 3/4 complications (P<0.001). Greater amounts of blood product transfusion were associated with longer hospital LOS (33.7 vs. 23 days; P<0.001), and ICU admission (5 vs. 3.4 days; P<0.001) and 12% increase in grade 3/4 complications (P<0.001). When corrected for weight and peritoneal cancer index (PCI), increased transfusion of blood products still resulted in longer hospital LOS (31.2 vs. 25.2 days; P=0.04) and longer ICU admission (4.7 vs. 3.6 days; P=0.03). On multivariable analysis, less blood product transfusions demonstrated a decreased LOS in hospital by 4.8 days (P=0.01) and fewer grade 3/4 complications (OR 0.59; 95% CI, 0.35-0.99; P=0.05). CONCLUSIONS: Greater IOF administration is associated with an increase in postoperative morbidity, including hospital LOS, ICU admission and grade 3/4 complications, in patients undergoing CRS/HIPEC.
BACKGROUND: Determine the effect of intraoperative fluids (IOFs) administered during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on postoperative patient outcomes. METHODS: Retrospective cohort study of patients that underwent CRS/HIPEC from February 2010 to June 2017. RESULTS: A total of 335 patients formed the cohort study. Patients who received higher IOFs had longer hospital length of stay (LOS) (34 vs. 22.5 days; P<0.001), extended intensive care unit (ICU) admission (5.3 vs. 3.2 days; P<0.001) and a 12% increase in grade 3/4 complications (P<0.001). Greater amounts of blood product transfusion were associated with longer hospital LOS (33.7 vs. 23 days; P<0.001), and ICU admission (5 vs. 3.4 days; P<0.001) and 12% increase in grade 3/4 complications (P<0.001). When corrected for weight and peritoneal cancer index (PCI), increased transfusion of blood products still resulted in longer hospital LOS (31.2 vs. 25.2 days; P=0.04) and longer ICU admission (4.7 vs. 3.6 days; P=0.03). On multivariable analysis, less blood product transfusions demonstrated a decreased LOS in hospital by 4.8 days (P=0.01) and fewer grade 3/4 complications (OR 0.59; 95% CI, 0.35-0.99; P=0.05). CONCLUSIONS: Greater IOF administration is associated with an increase in postoperative morbidity, including hospital LOS, ICU admission and grade 3/4 complications, in patients undergoing CRS/HIPEC.
Authors: Birgitte Brandstrup; Hanne Tønnesen; Randi Beier-Holgersen; Else Hjortsø; Helle Ørding; Karen Lindorff-Larsen; Morten S Rasmussen; Charlotte Lanng; Lene Wallin; Lene H Iversen; Christina S Gramkow; Mette Okholm; Tine Blemmer; Poul-Erik Svendsen; Henrik H Rottensten; Birgit Thage; Jens Riis; Inge S Jeppesen; Dorthe Teilum; Anne Mette Christensen; Ben Graungaard; Frank Pott Journal: Ann Surg Date: 2003-11 Impact factor: 12.969
Authors: H G Wakeling; M R McFall; C S Jenkins; W G A Woods; W F A Miles; G R Barclay; S C Fleming Journal: Br J Anaesth Date: 2005-09-09 Impact factor: 9.166