D. Holliday2, R. Gerard2, F. Velez-Cubian2, C. Moodie1, J. Garrett1, J. Fontaine1,2, E. Toloza1,2 1Moffitt Cancer Center And Research Institute,Tampa, FL, USA 2University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction: We investigated whether intraoperative fluids given to patients during robotic-assisted pulmonary lobectomy correlate with frequency of postoperative atrial fibrillation (PostOp Afib).
Method: We retrospectively studied all patients who underwent robotic-assisted pulmonary lobectomy from September 2010 through May of 2017 by one surgeon. A total of 419 patients were analyzed for types and volumes of intraoperative fluids received, such as intravenous (IV) crystalloid, colloid, packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets, and phenylephrine, for fluids that were lost during surgery, such as estimated blood loss (EBL) and urine output (UOP), and for the calculated balance of these fluids. These patients were then analyzed based on whether they had PostOp AFib (n=39) or not (n=380). We also grouped patients by level of intraoperative crystalloids given (<1500 mL, n=86; 1500-2500 mL, n=211; >2500 mL, n=122) and analyzed differences in demographics and in perioperative complications and outcomes. Statistical significance was defined as p-value≤0.05.
Results: Patients who had PostOp Afib had a significantly higher mean fluid balance than those without PostOp AFib (2273±499 mL vs 1532±100 mL; p=0.034), while none of the IV fluids given, including PRBC, FFP, platelets, or phenylephrine, nor EBL or UOP significantly differed between the two groups. When grouped by IV crystalloid volume received, proportionately more females receive <2500ml IV crystalloid, while proportionately more males received >2500 ml (p=0.012). Higher IV crystalloid volumes correlated with higher rates of intraoperative complications (p<0.001), which was mainly bleeding (p<0.001) during the robotic portion of the procedure (p<0.001), higher rates of overall conversions (p<0.001), emergent conversions due to bleeding (p<0.001), and elective conversions due to pleural or tumor adhesions (p=0.001), and higher rates of postoperative complications regardless of whether these were solely cardiac complications (p=0.003), solely pulmonary complications (p=0.012), or combined pulmonary and cardiac complications (p=0.001), but no individual complications correlated with IV crystalloid volume received (all p>0.206). Higher IV crystalloid volumes also correlated with EBL (p<0.001), skin-to-skin operative time (p<0.001), chest tube duration (p=0.006), and hospital length of stay (LOS; p=0.004)
Conclusion: Occurrence of PostOp Afib was associated with greater positive fluid balances after robotic-assisted pulmonary lobectomy, but not with greater volumes of crystalloid, colloid, PRBC, FFP, platelets, or phenylephrine received nor with EBL or UOP. Higher IV crystalloid volumes received were associated with higher conversion rates, EBL, and operative times, increased pulmonary and/or cardiac complication rates, and longer chest tube duration and hospital LOS.