Correlation of postoperative fluid balance and weight and their impact on outcomes
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ORIGINAL ARTICLE
Correlation of postoperative fluid balance and weight and their impact on outcomes Fabio Butti 1,2 & Basile Pache 1,3 Martin Hübner 1
&
Michael Winiker 1,4
&
Fabian Grass 1
&
Nicolas Demartines 1
&
Received: 7 April 2020 / Accepted: 29 September 2020 # The Author(s) 2020
Abstract Introduction Normovolemia after major surgery is critical to avoid complications. The aim of the present study was to analyze correlation between fluid balance, weight gain, and postoperative outcomes. Methods All consecutive patients undergoing elective or emergency major abdominal surgery needing intermediate care unit (IMC) admission from September 2017 to January 2018 were included. Postoperative fluid balances and daily weight changes were calculated for postoperative days (PODs) 0–3. Risk factors for postoperative complications (30-day Clavien) and prolonged length of IMC and hospital stay were identified through uni- and multinominal logistic regression. Results One hundred eleven patients were included, of which 55% stayed in IMC beyond POD 1. Overall, 67% experienced any complication, while 30% presented a major complication (Clavien ≥ III). For the entire cohort, median cumulative fluid balance at the end of PODs 0–1–2–3 was 1850 (IQR 1020–2540) mL, 2890 (IQR 1610–4000) mL, 3890 (IQR 2570–5380) mL, and 4000 (IQR 1890–5760) mL respectively, and median weight gain was 2.2 (IQR 0.3–4.3) kg, 3 (1.5–4.7) kg, and 3.9 (2.5–5.4) kg, respectively. Fluid balance and weight course showed no significant correlation (r = 0.214, p = 0.19). Extent of surgery, analyzed through Δ albumin and duration of surgery, significantly correlated with POD 2 fluid balances (p = 0.04, p = 0.006, respectively), as did POD 3 weight gain (p = 0.042). Prolonged IMC stay of ≥ 3 days was related to weight gain ≥ 3 kg at POD 2 (OR 2.8, 95% CI 1.01–8.9, p = 0.049). Conclusion Fluid balance and weight course showed only modest correlation. POD 2 weight may represent an easy and pragmatic tool to optimize fluid management and help to prevent fluid-related postoperative complications. Keywords Fluid balance . Weight gain . Complications . Outcome . Colorectal
Fabio Butti and Basile Pache should be considered joint first authors Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-02004-9) contains supplementary material, which is available to authorized users. * Martin Hübner [email protected]
Abbreviations ICU Intensive care unit IMC Surgical intermediate care unit ERAS Enhanced recovery after surgery POD Postoperative day PACU Postanesthesia care unit pRBCs Packed red blood cells PCA Anesthesia/patient controlled anesthesia CCI Comprehensive Complications Index
1
Department of Visceral Surgery, Lausanne University Hospital CHUV, Rue du Bugnon 46, CH – 1011 Lausanne, Switzerland
2
Department of General Surgery, GHOL Nyon Hospital, Ch. Monastier 10, 1260 Nyon, Switzerland
Introduction
3
Department of Gynaecology and Obstetrics, Lausanne University Hospital CHUV, Rue du Bugnon 46
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