The clinical impact of the systolic volume variation guided intraoperative fluid administration regimen on surgical outcomes after pancreaticoduodenectomy: a retrospective cohort study
O impacto clínico da variação do volume sistólico guiado pelo regime de administração de fluido intraoperatório nos resultados cirúrgicos após pancreaticoduodenectomia: um estudo de coorte retrospectivo
Daniel Negrini, Jacqueline Graaf, Mayan Ihsan, Ana Gabriela Correia, Karine Freitas, Jorge Andre Bravo, Tatiana Linhares, Patrick Barone
Abstract
Background
Pancreaticoduodenectomy is associated with high morbidity. Many preoperative variables are risk factors for postoperative complications, but they are primarily non-modifiable. It is not clear whether an intraoperative goal-directed fluid regimen might be associated with fewer postoperative surgical complications compared to current conservative, non-goal-directed fluid practices. We hypothesize that the use of Systolic Volume Variation (SVV)-guided intraoperative fluid administration might be beneficial.
Methods
Data from 223 patients who underwent pancreaticoduodenectomy in our institution between 2015 and 2019 were reviewed. Patients were classified into two groups based on the use of intraoperative use of SVV to guide the administration of fluids. The decision to use SVV or not was made by the attending anesthesiologist. Subjects were classified into SVV-guided intraoperative fluid therapy (SVV group) and non-SVV-guided intraoperative fluid therapy (non-SVV group). Uni and multivariate regression analyses were conducted to determine if SVV-guided fluid therapy was significantly associated with a lower incidence of postoperative surgical complications, such as Postoperative Pancreatic Fistula (POPF), Delayed Gastric Emptying (DGE), among others, after adjusting for confounders.
Results
Baseline, demographic, and intraoperative characteristics were similar between SVV and non-SVV groups. In the multivariate analysis, the use of SVV guidance was significantly associated with fewer postoperative surgical complications (OR = 0.48; 95% CI 0.25–0.91; p = 0.025), even after adjusting for significant covariates, such as perioperative use of epidural, pancreatic gland parenchyma texture, and diameter of the pancreatic duct.
Conclusions
VV-guided intraoperative fluid administration might be associated with fewer postoperative surgical complications after pancreaticoduodenectomy.
Keywords
Resumo
Justificativa: A pancreaticoduodenectomia está associada a alta morbidade. Muitas variáveis pré-operatórias são fatores de risco para complicações pós-operatórias, mas são primariamente não modificáveis. Não está claro se um regime intraoperatório de fluidos direcionado a metas pode estar associado a menos complicações cirúrgicas pós-operatórias em comparação com as práticas atuais conservadoras de fluidos não direcionadas a objetivos. Nossa hipótese é que o uso da administração de fluido intra-operatório guiada pela variação do volume sistólico (VVS) pode ser benéfico. Métodos: Foram revisados dados de 223 pacientes submetidos à pancreaticoduodenectomia em nossa instituição entre 2015 e 2019. Os pacientes foram classificados em dois grupos com base no uso do uso intraoperatório da VVS para orientar a administração de fluidos. A decisão de usar ou não a VVS foi tomada pelo anestesiologista assistente. Os indivíduos foram classificados em fluidoterapia intraoperatória guiada por VVS (grupo VVS) e fluidoterapia intraoperatória não guiada por VVS (grupo não VVS). Análises de regressão uni e multivariada foram realizadas para determinar se a fluidoterapia guiada por VVS estava significativamente associada a uma menor incidência de complicações cirúrgicas pós-operatórias, como fístula pancreática pós-operatória (FPPO), esvaziamento gástrico retardado (EGR), entre outras, após ajuste para fatores de confusão . Resultados: As características basais, demográficas e intraoperatórias foram semelhantes entre os grupos VVS e não VVS. Na análise multivariada, o uso da orientação VVS foi significativamente associado a menos complicações cirúrgicas pós-operatórias (OR = 0,48; IC 95%: 0,25–0,91; p = 0,025), mesmo após ajuste para covariáveis significativas, como uso perioperatório de peridural, textura do parênquima da glândula pancreática e diâmetro do ducto pancreático. Conclusões: A administração intraoperatória de fluidos guiada por VV pode estar associada a menos complicações cirúrgicas pós-operatórias após pancreaticoduodenectomia.
Palavras-chave
References
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