학술논문
Intraoperative crystalloid utilization variability and association with postoperative outcomes: A post hoc analysis of two multicenter prospective cohort studies.
Document Type
Academic Journal
Author
Ripollés-Melchor J; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain. Electronic address: ripo542@gmail.com.; Aldecoa C; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Cuidados Críticos, Hospital Universitario Río Hortega, Valladolid, Spain.; Alday-Muñoz E; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario La Princesa, Madrid, Spain.; Del Río S; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.; Batalla A; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Universitario Sant Pau, Barcelona, Spain.; Del-Cojo-Peces E; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Don Benito Vilanueva, Badajoz, Spain.; Uña-Orejón R; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Universitario La Paz, Madrid, Spain.; Muñoz-Rodés JL; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital General Universitario de Elche, Elche, Spain.; Lorente JV; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain.; Espinosa ÁV; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Department of Cardiothoracic and Vascular Anesthesia and Critical Care. MKCC Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain.; Ferrando-Ortolà C; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Jover JL; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Virgen de Los Lirios, Alcoy, Alicante, Spain.; Abad-Gurumeta A; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.; Ramírez-Rodríguez JM; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Cirugía, Hospital Universitario Lozano Blesa, Zaragoza, Spain.; Abad-Motos A; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
Source
Publisher: Elsevier España Country of Publication: Spain NLM ID: 101778594 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2341-1929 (Electronic) Linking ISSN: 23411929 NLM ISO Abbreviation: Rev Esp Anestesiol Reanim (Engl Ed) Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes.
Methods: We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS).
Results: 7580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval 1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.
(Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)
Methods: We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS).
Results: 7580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval 1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.
(Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)