Postoperative fluid overload is a risk factor for adverse surgical outcome in patients undergoing esophagectomy for esophageal cancer: a retrospective study in 335 patients

作者：Glatz Torben^*; Kulemann Birte; Marjanovic Goran; Bregenzer Svenja; Makowiec Frank; Hoeppner Jens

来源：BMC Surgery, 2017, 17(1): 6.

DOI：10.1186/s12893-016-0203-9

• Esophageal cancer
• Esophagectomy
• Perioperative fluid management
• Morbidity
• Adverse surgical outcome

Background: Restrictive intraoperative fluid management is increasingly recommended for patients undergoing esophagectomy. Controversy still exists about the impact of postoperative fluid management on perioperative outcome.
Methods: We retrospectively examined 335 patients who had undergone esophagectomy for esophageal cancer at the University Hospital Freiburg between 1996 and 2014 to investigate the relation between intra-and postoperative fluid management and postoperative morbidity after esophagectomy.
Results: Perioperative morbidity was 75%, the in-hospital mortality 8%. A fluid balance above average on the operation day was strongly associated with a higher rate of postoperative mortality (21% vs 3%, p < 0.001) and morbidity (83% vs 66%, p = 0.001). Univariate analysis for risk factors for adverse surgical outcome (Clavien >= III) identified ASA-score (p = 0.002), smoking (p = 0.036), reconstruction by colonic interposition (p = 0.036), cervical anastomosis (p = 0.017), blood transfusion (p = 0.038) and total fluid balance on the operation day and on POD 4 (p = 0.001) as risk factors. Multivariate analysis confirmed only ASA-score (p = 0.001) and total fluid balance (p = 0.001) as independent predictors of adverse surgical outcome.
Conclusion: Intra-and postoperative fluid overload is strongly associated with increased postoperative morbidity. Our results suggest restrictive intra-and especially postoperative fluid management to optimize the outcome after esophagectomy.

• 出版日期2017-1-13