V. Pandit1, M. Zeeshan1, C. Martinez1, P. Omesiete1, M. Hamidi1, Y. Villalvazo1, V. Nfonsam1 1University Of Arizona,Department Of Surgery,Tucson, AZ, USA
Introduction:
Post-operative leak (PoL) in patients undergoing colectomy for colon cancer is a known complication and associated with adverse outcomes. Multiple factors are established to impact (PoL) however; volume of intra-operative fluids (IoF) remains unclear. The aim of the study was to assess the impact of IOF on PoL in patients undergoing colon surgery. We hypothesized that minimizing IOF results in lower PoL.
Methods:
A 2 year (2016-2017) prospective analysis of all patients undergoing elective colon resection was performed. Patient data age, gender, co-morbidities, ASA score, indication of procedure, procedure type, IoF, post-operative outcomes for 30days were collected. Outcome measure was PoL. ROC analysis was performed to assess optimum cutoff for IoF.
Results:
A total of 160 patients were included with mean age was 64.5±15.6 years, 52.5% male, median ASA 3[3-4], median BMI 32[29-34], 45% of procedures were performed laparoscopic, the median IoF 1300 [1000-2500] and PoL was 7.5%. Among POL, 50% were colo-rectal and 33.3% were colo-anal anastomosis. Patients with PoL received higher IoF (1251±1122ml vs 3758±2100cc p=0.01). After controlling for demographics, procedure type, ASA, BMI, neoadjuvant therapy, anastomotic type, and operative duration higher IoF was independently associated with PoL (1.2 [1.1-2.6], p=0.03). On ROC analysis 1900cc was the optimum fluid cut-off for PoL.
Conclusion:
Intra-operative fluid volume significantly impacts post-operative leak after colon surgery. Minimizing intra-operative fluids to less than 1900cc crystalloids may help to reduce post-operative leak rate. Further studies validating optimum intra-operative fluids may help optimize patient care.