Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes.

Autor: Cetik RM; Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, USA. rizamert.cetik@louisville.edu., Gum JL; Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, USA., Lafage R; Northwell, Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA., Smith JS; Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA., Bess S; Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA., Mullin JP; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA., Kelly MP; Department of Orthopaedic Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA., Diebo BG; Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA., Buell TJ; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Scheer JK; Department of Neurological Surgery, University of California, San Francisco, CA, USA., Line BG; Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA., Lafage V; Northwell, Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA., Klineberg EO; Department of Orthopaedic Surgery, University of California-Davis, Davis, CA, USA., Kim HJ; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA., Passias PG; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA., Kebaish KM; Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA., Eastlack RK; Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA., Daniels AH; Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA., Soroceanu A; Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada., Mundis GM; Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA., Hostin RA; Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA., Protopsaltis TS; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA., Hamilton DK; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Hart RA; Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA., Gupta MC; Department of Orthopedic Surgery, Washington University, St Louis, MO, USA., Lewis SJ; Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada., Schwab FJ; Northwell, Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA., Lenke LG; Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA., Shaffrey CI; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA., Ames CP; Department of Neurological Surgery, University of California, San Francisco, CA, USA., Burton DC; Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
Jazyk: angličtina
Zdroj: Spine deformity [Spine Deform] 2024 Sep 12. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1007/s43390-024-00966-0
Abstrakt: Purpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).
Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input-output difference (IOD), and normalized input-output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes.
Results: Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = -0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004).
Conclusion: Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes.
Level of Evidence: III.
(© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)
Databáze: MEDLINE
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