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Association between the intraoperative fluid balance during cardiac surgery and postoperative sequential organ failure assessment score: a post hoc analysis of the BROTHER study, a retrospective multicenter cohort study

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Abstract

Although intraoperative intravenous fluids are commonly administered to reverse intraoperative hypotension during cardiac surgery, the appropriate volume remains unclear. This study aimed to evaluate the relationship between the intraoperative fluid balance and sequential organ failure assessment (SOFA) score in patients undergoing cardiac surgery to determine the impact of intraoperative intravenous fluids on their organs. This was a post hoc analysis using data from a multicenter, retrospective, observational study across 14 intensive care units (ICUs) in Japan. Adult patients admitted to ICUs after elective coronary artery bypass grafting or valve surgery from January 1 to December 31, 2018 were enrolled. We compared patients with intraoperative fluid balance < 20 ml/kg to those with fluid balance ≥ 20 ml/kg and conducted a multiple regression analysis for the SOFA score within 24 h of ICU admission. Of the 1567 included patients, 870 met the eligibility criteria. A total of 725 patients (83%) had an intraoperative fluid balance of ≥ 20 ml/kg. In the univariate analysis, the SOFA score (interquartile range) was 7 (6–8) and 7 (6–9) in the intraoperative fluid balance < 20 ml/kg and ≥ 20 ml/kg groups, respectively (p = 0.017). Multiple regression analysis showed a positive association between intraoperative fluid balance and SOFA score within 24 h of ICU admission [standardized coefficient 0.0065 (95% confidence interval 0.0036–0.0095), p < 0.001]. Intraoperative fluid balance in patients undergoing cardiac surgery was significantly associated with higher SOFA scores within 24 h of ICU admission.

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Data availability

The data supporting the findings of this study are available from the corresponding author, TK, upon reasonable request.

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Acknowledgements

We would like to thank the following colleagues from the participating hospitals associated with the BROTHER study, who performed the extensive data entry, namely: Jikei University School of Medicine: Takuo Yoshida; Kameda Medical Center: Yuki Kotani; Okinawa Chubu Hospital: Izumi Nakayama; Tottori University Faculty of Medicine: Masato Nakasone; Wakayama Medical University: Mami Shibata; Hokkaido University Hospital: Tomonao Yoshida; Kobe City Medical Center General Hospital: Akihisa Taguchi, Daisuke Kawakami; Hirosaki University Graduate School of Medicine: Noriko Mikami, Junichi Saito, Mirei Kubota, Tsubasa Oyama; Kurashiki Central Hospital: Jun Kamei; Yokohama City Minato Red Cross Hospital: Isao Nagata, Shinsuke Karatsu; Tokyo Bay Urayasu Ichikawa Medical Center: Naoki Yamaguchi; Yokohama City University Hospital: Takayuki Kariya; Iwate Prefectural Central Hospital: Hiroshi Nashiki; and Hiroshima Citizens Hospital: Koji Kido, Hiroki Omiya.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Ishikawa Prefectural Central Hospital, 2-1, Kuratsuki higashi, Kanazawa, 920-8530, Japan

    Takahiro Koga

  2. Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2, Seto, Kanazawa, Yokohama, 236-0027, Japan

    Takuo Yoshida

  3. Intensive Care Unit, Department of Emergency Medicine, Jikei University School of Medicine, 3-19-18, Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan

    Takuo Yoshida

  4. Department of Intensive Care Medicine, Kameda Medical Center, 929, Higashimachi, Kamogawa, Chiba, 296-8602, Japan

    Yuki Kotani

  5. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Yuki Kotani

  6. School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy

    Yuki Kotani

Authors
  1. Takahiro Koga
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  2. Takuo Yoshida
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Consortia

The BROTHER study group

  • Takuo Yoshida
  • , Yuki Kotani
  • , Izumi Nakayama
  • , Masato Nakasone
  • , Mami Shibata
  • , Tomonao Yoshida
  • , Akihisa Taguchi
  • , Daisuke Kawakami
  • , Noriko Mikami
  • , Junichi Saito
  • , Mirei Kubota
  • , Tsubasa Oyama
  • , Jun Kamei
  • , Isao Nagata
  • , Shinsuke Karatsu
  • , Naoki Yamaguchi
  • , Takayuki Kariya
  • , Hiroshi Nashiki
  • , Koji Kido
  •  & Hiroki Omiya

Contributions

TK had full access to all data in the study and takes responsibility for the integrity of the data. Study concept and design: TK, TY, and YK. Acquisition of data: TK, TY and YK. Analysis and interpretation of data: TK, TY, and YK. Drafting of the manuscript: TK. Critical revision of the manuscript for important intellectual content: TK, TY, and YK.

Corresponding author

Correspondence to Takahiro Koga.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The ethics committee of The Kameda Medical Center (No. 19-013) and the ethics committees of all other participating hospitals approved the opt-out method of informed consent. As this was a retrospective cohort study, we applied the opt-out method to obtain informed consent for participation.

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As this was a retrospective cohort study, we applied the opt-out method of informed consent for publication.

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The members of the BROTHER study group are presented in Acknowledgements section.

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Koga, T., Yoshida, T., Kotani, Y. et al. Association between the intraoperative fluid balance during cardiac surgery and postoperative sequential organ failure assessment score: a post hoc analysis of the BROTHER study, a retrospective multicenter cohort study. Heart Vessels 39, 57–64 (2024). https://doi.org/10.1007/s00380-023-02306-0

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