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- Title
Fluid management for critical patients undergoing urgent colectomy.
- Authors
Grass, Fabian; Pache, Basile; Butti, Fabio; Solà, Josep; Hahnloser, Dieter; Demartines, Nicolas; Hübner, Martin
- Abstract
Rationale: The present study aimed to define thresholds for perioperative fluids and weight gain after urgent colectomies. Method: Consecutive urgent colonic resections within an enhanced recovery pathway (2011‐2017) were included. Primary outcomes were postoperative complications, stratified as overall (I‐V) and major (IIIb‐V) according to Clavien scale. Fluid‐management–related thresholds were identified through receiver operating characteristics (ROC) analysis. Outcomes were compared for patients above vs below threshold, and multivariable logistic regression was performed to identify risk factors for overall complications. Results: Overall, complications were observed in 133 out of 224 patients (59%), severe complications in 43 patients (19%). For overall complications, area under ROC (AUROC) was 0.71, identifying a critical cut‐off of 3 L of total IV fluid administration at the day of surgery (negative predictive value [NPV]: 90%). Further, a critical cut‐off for postoperative weight gain of 2.3 kg at postoperative day (POD) 2 was identified (AUROC 0.7, NPV 92%). Multivariable analysis identified fluid administration of >3 L (OR 5.33; 95% CI, 2.36‐12.02) and weight gain of >2.3 kg at POD 2 (OR 2.5; 95% CI, 1.13‐5.53) as independent predictors for overall complications. Median length of stay was 7 (5‐10) days in patients receiving <3 L at POD 0 and 13 (9‐19) days in patients receiving >3 L (P <.001). Conclusions: Fluid administration of 3 L at the day of surgery and weight gain of 2.3 kg at POD 2 may represent critical thresholds for adverse outcomes after urgent colectomy. The suggested thresholds need to be confirmed through independent validation.
- Subjects
SURGICAL complication risk factors; COLECTOMY; CONFIDENCE intervals; CONVALESCENCE; CRITICALLY ill; LENGTH of stay in hospitals; EVALUATION of medical care; MULTIVARIATE analysis; PATIENTS; RESEARCH; SURGICAL complications; WATER-electrolyte balance (Physiology); WEIGHT gain; PAIN management; MULTIPLE regression analysis; RECEIVER operating characteristic curves; HYPODERMOCLYSIS; DATA analysis software; DESCRIPTIVE statistics; PERIOPERATIVE care; ODDS ratio
- Publication
Journal of Evaluation in Clinical Practice, 2020, Vol 26, Issue 1, p109
- ISSN
1356-1294
- Publication type
Article
- DOI
10.1111/jep.13207