Excess intraoperative fluid volume administration is associated with pancreatic fistula after pancreaticoduodenectomy

Abstract Recent studies on perioperative fluid administration in patients undergoing pancreaticoduodenectomy (PD) have suggested that increased fluid loads are associated with worse perioperative outcomes. The purpose of this study was to investigate the relationship between intraoperative fluid (IOF) administration and postoperative pancreatic fistula (POPF), and to determine additional risk factors affecting pancreatic fistula in patients undergoing PD. From 2005 to 2014, a total of 182 patients with various periampullary diseases after PD were reviewed retrospectively at Dongguk University Ilsan Hospital, Chung-Ang University Hospital, and Dongnam Institute of Radiological and Medical Sciences. Patients were assigned to high or low IOF groups based on more or less fluid administration for supplementation of estimated blood loss and maintenance volume (12.5 mL/kg/h) than planned, respectively. The associations between IOF administration, pancreatic fistula development, and perioperative outcomes were evaluated. A total of 98 patients were assigned to the high-IOF group, and 84 to the low-IOF group. Risk factors for pancreatic fistula after univariate analysis were assignment to the high-IOF group, higher preoperative serum hemoglobin level, ampullary or bile duct cancer, pylorus preserving PD, small pancreatic duct, duct-to-mucosa pancreatojejunostomy, use of a stent, and mesh application to pancreatojejunal anastomosis. Among these, assignment to the high-IOF group (hazard ratio [HR] = 5.501, 95% CI 1.624–18.632, P = .006) and a small (<4 mm) pancreatic duct (HR = 4.129, 95% CI 1.569–14.658, P = .035) were identified as independent risk factors for the development of pancreatic fistula after multivariate analysis. However, long-term survival rate did not differ according to IOF group or duct size. Excessive IOF volume administration is associated with an increased incidence of pancreatic fistula after pancreaticoduodenectomy.

[1]  J. Hodson,et al.  Comparison of preoperative CT-based imaging parameters to predict postoperative pancreatic fistula. , 2016, Clinical radiology.

[2]  E. Kınacı,et al.  Intraoperative acidosis is a new predictor for postoperative pancreatic fistula after pancreaticoduodenectomy. , 2016, Hepatobiliary & pancreatic diseases international : HBPD INT.

[3]  J. Heo,et al.  Randomized multicentre trial comparing external and internal pancreatic stenting during pancreaticoduodenectomy , 2016, The British journal of surgery.

[4]  N. Jamieson,et al.  Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. , 2014, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[5]  N. Tomita,et al.  A Pancreaticoduodenectomy Risk Model Derived From 8575 Cases From a National Single-Race Population (Japanese) Using a Web-Based Data Entry System: The 30-Day and In-hospital Mortality Rates for Pancreaticoduodenectomy , 2014, Annals of surgery.

[6]  Ning Li,et al.  The Effect of Intraoperative Fluid Volume Administration on Pancreatic Fistulas after Pancreaticoduodenectomy , 2014, Journal of investigative surgery : the official journal of the Academy of Surgical Research.

[7]  J. Norton,et al.  Postoperative Serum Amylase Predicts Pancreatic Fistula Formation Following Pancreaticoduodenectomy , 2014, Journal of Gastrointestinal Surgery.

[8]  D. Carpizo,et al.  Intraoperative fluid administration is associated with perioperative outcomes in pancreaticoduodenectomy: A single center retrospective analysis , 2013, Journal of surgical oncology.

[9]  M. Hiyoshi,et al.  Usefulness of Drain Amylase, Serum C-Reactive Protein Levels and Body Temperature to Predict Postoperative Pancreatic Fistula After Pancreaticoduodenectomy , 2013, World Journal of Surgery.

[10]  J. Hodson,et al.  Pre-operative prediction of pancreatic fistula: is it possible? , 2013, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.].

[11]  Y. Sakamoto,et al.  A Preoperative Predictive Scoring System for Postoperative Pancreatic Fistula after Pancreaticoduodenectomy , 2011, World Journal of Surgery.

[12]  M. Gonen,et al.  Relationship Between Intraoperative Fluid Administration and Perioperative Outcome After Pancreaticoduodenectomy: Results of a Prospective Randomized Trial of Acute Normovolemic Hemodilution Compared With Standard Intraoperative Management , 2010, Annals of surgery.

[13]  C. Bassi,et al.  Early Versus Late Drain Removal After Standard Pancreatic Resections: Results of a Prospective Randomized Trial , 2010, Annals of surgery.

[14]  Z. Juanjuan,et al.  Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy. , 2010, Surgery.

[15]  N. Secher,et al.  ‘Liberal’ vs. ‘restrictive’ perioperative fluid therapy – a critical assessment of the evidence , 2009, Acta anaesthesiologica Scandinavica.

[16]  M. Koch,et al.  Meta‐analysis of standard, restrictive and supplemental fluid administration in colorectal surgery , 2009, The British journal of surgery.

[17]  M. Jacob,et al.  A Rational Approach to Perioperative Fluid Management , 2008, Anesthesiology.

[18]  M. Callery,et al.  Risk Prediction for Development of Pancreatic Fistula Using the ISGPF Classification Scheme , 2008, World Journal of Surgery.

[19]  D. Litwin,et al.  Perioperative Mortality for Pancreatectomy: A National Perspective , 2007, Annals of surgery.

[20]  J. Cameron,et al.  One Thousand Consecutive Pancreaticoduodenectomies , 2006, Annals of surgery.

[21]  S. Connor,et al.  Meta‐analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery , 2005, The British journal of surgery.

[22]  S. Einav,et al.  Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery , 2005, Anesthesiology.

[23]  J. Neoptolemos,et al.  Postoperative pancreatic fistula: an international study group (ISGPF) definition. , 2005, Surgery.

[24]  H. Kehlet,et al.  Liberal Versus Restrictive Fluid Administration to Improve Recovery After Laparoscopic Cholecystectomy: A Randomized, Double-Blind Study , 2004, Annals of surgery.

[25]  Y. Mintz,et al.  Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. , 2003, Annals of surgery.

[26]  F. Pott,et al.  Effects of Intravenous Fluid Restriction on Postoperative Complications: Comparison of Two Perioperative Fluid Regimens: A Randomized Assessor-Blinded Multicenter Trial , 2003, Annals of surgery.

[27]  D. Lobo,et al.  Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial , 2002, The Lancet.

[28]  G. Barclay,et al.  Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation. , 2001, Archives of surgery.

[29]  S. Clack,et al.  Cause of metabolic acidosis in prolonged surgery. , 1999, Critical care medicine.

[30]  T. K. Hunt,et al.  Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. , 1991, Annals of surgery.

[31]  B. Bistrian,et al.  Postoperative fluid overload: not a benign problem. , 1990, Critical care medicine.

[32]  T. Kent,et al.  A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. , 2013, Journal of the American College of Surgeons.

[33]  Steven P. Cohen,et al.  Effect of intra‐operative fluid volume on peri‐operative outcomes after pancreaticoduodenectomy for pancreatic adenocarcinoma , 2012, Journal of surgical oncology.

[34]  A. Møller,et al.  Perioperative risk factors in elective pneumonectomy: the impact of excess fluid balance. , 2002, European journal of anaesthesiology.

[35]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.