Fluid therapy and surgical outcomes after low anterior resection

Česká verze

Authors: P. Kocian; J. Neumann; P. Majtan; J. Hoch
Authors place of work: Chirurgická klinika 2. LF UK a FN Motol, přednosta: prof. MUDr. J. Hoch, CSc.
Published in the journal: Rozhl. Chir., 2014, roč. 93, č. 9, s. 463-467.
Category: Původní práce

Summary

Introduction:
Fluid therapy is a fundamental component of surgical care. Recent data regarding fluid restriction has shown an association with improved outcomes. The aim of this study is to determine whether the use of restrictive approaches in perioperative fluid administration improves patient outcomes following low anterior resection.

Material and methods:
89 patients undergoing low anterior resection included in this study were divided by the median 14.9 mL/kg/h into group A (7.4–14.7 mL/kg/h) and group B (14.9–36.8 mL/kg/h) within intraoperative fluid administration, and by the median 3.3 mL/kg/h into group C (2.0–3.3 mL/kg/h) and group D (3.3–6.9 mL/kg/h) for fluid administration on the day of surgery. The main outcomes measured were cardiac and pulmonary complications, the incidence of anastomotic leak and wound infections, gastrointestinal function recovery, laboratory inflammatory markers and the length of hospital stay.

Results:
The restricted perioperative fluid regimen significantly reduced the risk of pleural effusion and anastomotic leak in patients after low anterior resection. The overall incidence of anastomotic leak was 9.0%. Another significant risk factor for anastomotic leak was neoadjuvant radiochemotherapy (15.9% vs. 2.2%, p=0.03).

Conclusion:
The restricted perioperative fluid regimen reduces postoperative morbidity in patients after low anterior resection. Hospital stay remains unchanged.

Key words:
fluid therapy − perioperative management − fluid restriction − low anterior resection − anastomotic leak

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