Objectives
Esophagectomy is associated with significant morbidity and mortality. The authors
assessed the relationship between intraoperative fluid (IOF) administration and postoperative
pulmonary outcomes in patients undergoing a transthoracic, transhiatal, or tri-incisional
esophagectomy.
Design
Retrospective cohort study (level 3 evidence).
Setting
Tertiary care referral center.
Participants
Patients who underwent esophagectomy from 2007 to 2017.
Interventions
The IOF rate (mL/kg/h) was the predictor variable analyzed both as a continuous and
binary categorical variable based on median IOF rate for this cohort (11.90 mL/kg/h).
Measurements
Primary outcomes included rates of acute respiratory distress syndrome (ARDS) within
ten days after esophagectomy. Secondary outcomes included rates of reintubation, pneumonia,
cardiac or renal morbidity, intensive care unit admission, length of stay, procedure-related
complications, and mortality. Multivariate regression analysis determined associations
between IOF rate and postoperative outcomes. Analysis was adjusted for age, sex, body
mass index, procedure type, year, and thoracic epidural use.
Main Results
A total of 1,040 patients comprised this cohort. Tri-incisional esophagectomy was
associated with a higher hospital mortality rate (7.8%) compared with transthoracic
esophagectomy (2.6%, p = 0.03) or transhiatal esophagectomy (0.7%, p = 0.01). Regression analysis revealed a higher IOF rate was associated with greater
ARDS within ten days (adjusted odds ratio [OR] = 1.03, p = 0.01). For secondary outcomes, a higher IOF rate was associated with greater hospital
mortality (adjusted OR = 1.05, p = 0.002), although no significant association with 30-day hospital mortality was
identified.
Conclusions
Increased IOF administration during esophagectomy may be associated with worse postoperative
pulmonary complications, specifically ARDS. Future well-powered studies are warranted,
including randomized, controlled trials comparing liberal versus restrictive fluid
administration in this surgical population.
Key Words
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Article info
Publication history
Published online: January 12, 2021
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