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Perioperative Net Fluid Balance Predicts Pancreatic Fistula After Pancreaticoduodenectomy

  • Original Article
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Journal of Gastrointestinal Surgery

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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Authors and Affiliations

  1. Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

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

  2. Section of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267-0558, USA

    Syed A. Ahmad & Sameer H. Patel

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  1. Leah K. Winer
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All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the Journal of Gastrointestinal Surgery.

CATEGORY 1

Conception and design of study:

Leah K Winer, Vikrom K Dhar, Syed A Ahmad, Sameer H Patel

Acquisition of data:

Leah K Winer, Tiffany C Lee, Mackenzie C Morris

Analysis and/or interpretation of data:

Leah K Winer, Vikrom K Dhar, Koffi Wima, Shimul A Shah, Syed A Ahmad, Sameer H Patel

CATEGORY 2

Drafting the manuscript:

Leah K Winer, Vikrom K Dhar, Sameer H Patel

Revising the manuscript critically for important intellectual content:

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

CATEGORY 3

Final approval of the version of the manuscript to be published:

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

CATEGORY 4

Agreement to be accountable for all aspects of the work:

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

Corresponding author

Correspondence to Sameer H. Patel.

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Winer, L.K., Dhar, V.K., Wima, K. et al. Perioperative Net Fluid Balance Predicts Pancreatic Fistula After Pancreaticoduodenectomy. J Gastrointest Surg 22, 1743–1751 (2018). https://doi.org/10.1007/s11605-018-3813-y

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