M. Asai1, A. X. Samayoa1, C. Hodge1, Y. Shan1, H. Pak1, T. Vu1 1Abington Memorial Hospital,General Surgery,Abington, PA, USA
Introduction:
Intraoperative intravenous (IV) fluid infusion has been controversial in thoracic surgery. There has been some studies showing correlation of intravenous fluid infusion and acute lung injury in the perioperative phase. Although this is the case, there is limited evidence suggesting volume of perioperative IV fluids and any correlation with outcomes in patients undergoing thoracic surgery. In our study, we investigated outcome measures associated with patients undergoing lung resection for non-small cell lung cancer (NSCLC) and the correlation with perioperative IV fluids.
Methods:
A retrospective review of consecutive patients undergoing open lobectomy for primary NSCLC from January 2010 to June 2016. Exclusion criteria were patients who had previous lung resection(s), blood loss more than 500cc during surgery and patients receiving intraoperative blood transfusions. Patient were divided into those receiving intraoperative IV fluid greater or less than 7 cc/kg/hr, and another group receiving greater or less than 10 cc/kg/hr. Perioperative (intraoperative + 24 hour postop) IV fluid were also recorded. We compared this against patient’s demographics, intraoperative parameters and complication rate within 30 days of surgery. Complications were categorized as pulmonary, cardiac, renal complications as well as hemorrhage, death and reoperation.
Results:
142 patients (69 male and 73 female) with the mean age of 66.5 years were identified following inclusion criteria were met. There was no significant difference in the hospital or ICU stay between any of the intraoperative or perioperative fluid groups.
Patients receiving greater than 10cc/kg/hr intraoperative IV fluid has higher rate of total complication, especially postoperative hemorrhage and reoperation rate. Patients receiving less than 7 cc/kg/hr intraoperative IV fluid has higher risk of developing acute renal injury. Patient who had greater than 1.5 cc/kg/hr perioperative fluid has significantly higher duration of chest tube in-situ, pulmonary complications and total complication rates.
Conclusion:
In our study, giving high amount of intraoperative and perioperative IV fluid has adverse effects on postoperative complications. Conversely, giving less (<7cc/kg/hr) intraoperative IV fluid has higher risk of renal dysfunction. We propose the optimal amount of intraoperative and perioperative IV fluid given should be in between these two extremes. To highlight these points further, a larger prospective randomized study should be performed.
