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.
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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.
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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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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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DOI: https://doi.org/10.1007/s00380-023-02306-0