Relationship Between Intraoperative Fluid Administration and Perioperative Outcome After Pancreaticoduodenectomy
- 1 December 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 252 (6), 952-958
- https://doi.org/10.1097/sla.0b013e3181ff36b1
Abstract
Pancreaticoduodenectomy (PD) can be associated with significant blood loss and transfusion requirements, with potential adverse short- and long-term consequences. The aim of this study was to determine whether acute normovolemic hemodilution (ANH), an established blood conservation technique, reduces perioperative allogeneic transfusions in patients undergoing PD. One hundred thirty patients undergoing PD were randomized to ANH or standard management (STDM). In the ANH group, intraoperative blood collection was performed to a target hemoglobin of 8.0 g/dL; crystalloid and colloid were used for volume replacement. Strict transfusion triggers were applied during and after operation. Perioperative complications were prospectively assessed and graded for severity. From July 2005 to May 2009, 209 patients were registered, 79 excluded, 65 were randomized to ANH, and 65 to STD. The groups were well matched for demographic, operative, and histopathologic variables. Patients undergoing ANH received over 2 L more fluid intraoperatively (6250 mL, range 2000-11850) compared with patients undergoing STD (3900 mL, range 2000-9000) (P < 0.001). Transfusion rates were similar (ANH = 16.9%, 30 units vs STD = 18.5%, 33 units; P = 0.82), as was overall perioperative morbidity (ANH = 49.2% vs STD = 47%, P = 0.86). There was, however, a trend toward more grade-3 complications in patients undergoing ANH (32% vs 23.1% STD, P = 0.17), and complications related to the pancreatic anastomosis (leak/fistula/abscess) were significantly higher in the ANH group (21.5% vs 7.7%, P = 0.045). The intraoperative fluid volume was higher for all patients with pancreatic anastomotic complications (n = 19), regardless of randomization arm (ANH 6000 mL, range 2800-11350 mL vs STD 5000 mL, range 2000-11850 mL, P < 0.042). In this randomized trial of patients undergoing PD, ANH did not reduce allogeneic transfusions and resulted in more pancreatic anastomotic complications, likely related to greater intraoperative fluid administration. The benefits of ANH do not necessarily extend to all procedures, and restrictive intravenous fluid management during PD may help improve postoperative outcome.Keywords
This publication has 43 references indexed in Scilit:
- Goal-directed Colloid Administration Improves the Microcirculation of Healthy and Perianastomotic ColonAnesthesiology, 2009
- Impact of Different Crystalloid Volume Regimes on Intestinal Anastomotic StabilityAnnals of Surgery, 2009
- A Prospective Randomized Trial of Acute Normovolemic Hemodilution Compared to Standard Intraoperative Management in Patients Undergoing Major Hepatic ResectionAnnals of Surgery, 2008
- Perioperative transfusion for pancreaticoduodenectomy and its impact on prognosis in resected pancreatic ductal adenocarcinomaHPB, 2007
- No mortality after 150 consecutive pancreatoduodenctomies with duct‐to‐mucosa pancreaticogastrostomyJournal of Surgical Oncology, 2007
- A Prospective Randomized Controlled Trial of Multimodal Perioperative Management Protocol in Patients Undergoing Elective Colorectal Resection for CancerAnnals of Surgery, 2007
- Effects of Intravenous Fluid Restriction on Postoperative Complications: Comparison of Two Perioperative Fluid RegimensAnnals of Surgery, 2003
- An Evidence-Based Approach to the Surgical Management of Resectable Pancreatic AdenocarcinomaJournal of the American College of Surgeons, 2003
- Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgeryJournal of Clinical Anesthesia, 1990
- Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomosesBritish Journal of Surgery, 1983