Intraoperative crystalloid utilization variability and association with postoperative outcomes: A post hoc analysis of two multicenter prospective cohort studies
Por:
Ripolles-Melchor, J, Aldecoa, C, Alday-Munoz, E, del Rio, S, Batalla, A, del-Cojo-Peces, E, Una-Orejon, R, Munoz-Rodes, J, Lorente, J, Espinosa, A, Ferrando-Ortola, C, Jover, J, Abad-Gurumeta, A, Ramirez-Rodriguez, J, Abad-Motos, A and Nombre Grp Investigadores Estudio
Publicada:
1 ago 2021
Ahead of Print:
1 jul 2021
Resumen:
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: 7,580 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 intervatl .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. (C) 2020 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Ripolles-Melchor, J:
Hosp Univ Infanta Leonor, Dept Anestesia & Med Perioperat, Madrid, Spain
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Aldecoa, C:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Hosp Univ Rio Hortega, Dept Anestesia & Cuidados Crit, Valladolid, Spain
Alday-Munoz, E:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Hosp Univ Princesa, Dept Anestesia & Med Perioperat, Madrid, Spain
del Rio, S:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Complejo Hosp Univ Santiago, Dept Anestesia, Santiago De Compostela, Spain
Batalla, A:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Hosp Univ St Pau, Dept Anestesia, Barcelona, Spain
del-Cojo-Peces, E:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Hosp Don Benito Villanueva, Dept Anestesia, Badajoz, Spain
Una-Orejon, R:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Hosp Univ La Paz, Dept Anestesia, Madrid, Spain
:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Hosp Gen Univ Elche, Dept Anestesia & Med Perioperat, Elche, Spain
Lorente, J:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Hosp Univ Juan Ramon Jimenez, Dept Anestesia & Med Perioperat, Huelva, Spain
Espinosa, A:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
MKCC Mohammed Bin Khalifa Cardiac Ctr, Dept Cardiothorac & Vasc Anesthesia & Crit Care, Royal Med Serv, Awali, Bahrain
Ferrando-Ortola, C:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer, Dept Anestesiol & Cuidados Crit, Barcelona, Spain
Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain
:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Hosp Virgen Lirios, Dept Anestesia & Med Perioperat, Alicante, Alcoy, Spain
Abad-Gurumeta, A:
Hosp Univ Infanta Leonor, Dept Anestesia & Med Perioperat, Madrid, Spain
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Ramirez-Rodriguez, J:
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
Hosp Univ Lozano Blesa, Dept Cirugia, Zaragoza, Spain
Abad-Motos, A:
Hosp Univ Infanta Leonor, Dept Anestesia & Med Perioperat, Madrid, Spain
Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain
Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain
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