Intraoperative Fluid Resuscitation Strategies in Pancreatectomy: Results from 38 Hospitals in Michigan.

Autor: Healy MA; Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA. healym@umich.edu., McCahill LE; Metro Health Hospital, Wyoming, MI, USA., Chung M; Spectrum Health Medical Group, Grand Rapids, MI, USA., Berri R; St. John Providence Hospitals, Grosse Pointe Woods, MI, USA., Ito H; Michigan State University, Lansing, MI, USA., Obi SH; Allegiance Health, Jackson, MI, USA., Wong SL; Dartmouth Geisel School of Medicine, Hanover, NH, USA., Hendren S; Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA., Kwon D; Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2016 Sep; Vol. 23 (9), pp. 3047-55. Date of Electronic Publication: 2016 Apr 26.
DOI: 10.1245/s10434-016-5235-y
Abstrakt: Background: Fluid administration practices may affect complication rates in some abdominal surgeries, but effects in patients undergoing pancreatectomy are not understood well. We sought to determine whether amount of intraoperative fluid administered to patients undergoing pancreatectomy is associated with postoperative complication rates and to determine whether hospitals vary in their fluid administration practices.
Methods: Data for 504 patients undergoing pancreatectomy at 38 hospitals between 2012 and 2015 were evaluated. The main exposure was intraoperative fluid administration (≤10, 10-15, >15 mL/kg/h). Mortality, complications, and length of stay were the main outcomes of interest. Patient-level associations between exposure and outcome were tested, with adjustment for potentially confounding patient and surgical factors, using random intercept, mixed-effects linear or logistic regression models. Hospitals were then categorized as having a restrictive, intermediate, or liberal resuscitation practice, and adjusted outcomes were compared.
Results: A total of 167 (33.1 %), 185 (36.7 %) and 152 (30.2 %) patients received restrictive, intermediate, or liberal fluid administration, respectively. Hospitals with more restrictive practices had significantly lower adjusted 30-day mortality than those with more liberal practices (2.7 vs. 6.6 %; P < 0.001). Hospitals with more restrictive practices had the lowest rates of severe (Grade 2 and 3) complications (15.4 % restrictive vs. 25.3 % intermediate vs. 44.3 % liberal; P < 0.001). More restrictive hospitals had decreased adjusted mean length of stay (9.5 days vs. 12.7 days intermediate vs. 11.6 days liberal; P < 0.001).
Conclusions: More restrictive intraoperative resuscitation practices in pancreatectomy are associated with decreased hospital-level mortality, severe complications, and length of stay.
Databáze: MEDLINE
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