Effect of perioperative fluid management on postoperative pulmonary complications of esophagectomy: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Hui , YANG Mei , NIU Lingli ,  HU Yang

Department of Thoracic Surgery, West China Hospital, Chengdu, 610041, P.R.China;

Corresponding author：

HU Yang, Email: huyangforests@163.com

Keywords：

Esophageal cancer; fluid management; postoperative pulmonary complications

DOI：

10.7507/1007-4848.201605025

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Objective To evaluate the effect of perioperative fluid management on postoperative pulmonary complications (PPCs) of esophagectomy, and to find out the optimal scheme for perioperative fluid administration. Methods This retrospective cohort study enrolled 75 patients with esophageal squamous cell cancer who have received esophagectomy in West China Hospital from June to December 2014. We used the Kroenke's postoperative pulmonary complications classification system to define the PPCs. Patients with PPCs of grade Ⅱ-Ⅳ were considered as PPCs group (n=13, 12 males, 1 female, age of 64.62±8.64 years), and others were considered as non-complication group (n=62, 50 males, 12 females, age of 60.55±8.73 years). Intraoperative and postoperative fluid inputs and outputs as well as clinical characteristics between groups were compared. Results Between two groups, there was a great difference in postoperative albumin infusion, intraoperative fluid administration [net input, total input, net input/kg, total input/kg, net input/(kg·h) and total input/(kg·h)] and fluid input on the first postoerative 1–3 days (total input and total input/kg). The cutoff value for total input/(kg·h) in operation and total input on the first 1–3 postoerative days was 12.07 ml/(kg·h) and 178.57 ml/kg, respectively. Conclusion The speed of fluid infusion in operation and total input on postoperative 1-3 days are most important influence factors of PPCs. The speed in operation should not exceed 12.07 ml/(kg·h) and the total input on postoperative 1-3 days should not exceed 178.57 ml/kg. Within this range, an appropriate increase in fluid volume can make patients feel better.

Citation： XU Hui, YANG Mei, NIU Lingli, HU Yang. Effect of perioperative fluid management on postoperative pulmonary complications of esophagectomy: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(5): 338-345. doi: 10.7507/1007-4848.201605025 Copy

1.	Bailey SH, Bull DA, Harpole DH, et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg, 2003, 75(1): 217-222.
2.	Karl RC, Schreiber R, Boulware D, et al. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg, 2000, 231(5): 635-643.
3.	Ryan AM, Hearty A, Prichard RS, et al. Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy. J Gastrointest Surg, 2007, 11(10): 1355-1360.
4.	Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol, 2004, 11(7): 682-689.
5.	Law SY, Fok M, Wong J. Risk analysis in resection of squamous cell carcinoma of the esophagus. World J Surg, 1994, 18(3): 339-346.
6.	Whooley BP, Law S, Murthy SC, et al. Analysis of reduced death and complication rates after esophageal resection. Ann Surg, 2001, 233(3): 338-344.
7.	Takeno S, Takahashi Y, Watanabe S, et al. Esophagectomy in patients aged over 80 years with esophageal cancer. Hepatogastroenterology, 2008, 55(82-83): 453-456.
8.	Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol, 2006, 20(2): 265-283.
9.	Griffin SM, Shaw IH, Dresner SM. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management. J Am Coll Surg, 2002, 194(3): 285-297.
10.	Healy LA, Ryan AM, Gopinath B, et al. Impact of obesity on outcomes in the management of localized adenocarcinoma of the esophagus and esophagogastric junction. J Thorac Cardiovasc Surg, 2007, 134(5): 1284-1291.
11.	Brodner G, Pogatzki E, Van Aken H, et al. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg, 1998, 86(2): 228-234.
12.	Neal JM, Wilcox RT, Allen HW, et al. Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction. Reg Anesth Pain Med, 2003, 28(4): 328-334.
13.	Sato N, Koeda K, Ikeda K, et al. Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg, 2002, 236(2): 184-190.
14.	Raimondi AM, Guimarães HP, Amaral JL, et al. Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma. Sao Paulo Med J, 2006, 124(2): 11211-11215.
15.	Takeda S, Takeda S, Kim C, et al. Preoperative administration of methylprednisolone attenuates cytokine-induced respiratory failure after esophageal resection. J Nippon Med Sch, 2003, 70(1): 16-20.
16.	Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg, 1998, 86(3): 598-612.
17.	Cense HA, Lagarde SM, de Jong K, et al. Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection. J Am Coll Surg, 2006, 202(3): 395-400.
18.	Casado D, Lopez F, Marti R. Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus, 2010, 23(7): 523-528.
19.	Wei S, Tian J, Song X, et al. Association of perioperative fluid balance and adverse surgical outcomes in esophageal cancer and esophagogastric junction cancer. Ann Thorac Surg, 2008, 86(1): 266-272.
20.	Kroenke K, Lawrence VA, Theroux JF, et al. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med, 1992, 152(5): 967-971.
21.	D'journo XB, Michelet P, Avaro JP, et al. Respiratory complications after oesophagectomy for cancer. Rev Mal Respir, 2008, 25(6): 683-694.
22.	Atkins BZ, Fortes DL, Watkins KT. Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk. Dysphagia, 2007, 22(1): 49-54.
23.	Nishi M, Hiramatsu Y, Hioki K, et al. Pulmonary complications after subtotal oesophagectomy. Br J Surg, 1988, 75(6): 527-530.
24.	Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev, 2016, 2: CD009121.
25.	Chandrashekar MV, Irving M, Wayman J, et al. Immediate extubation and epidural analgesia allow safe management in a high-dependency unit after two-stage oesophagectomy. Results of eight years of experience in a specialized upper gastrointestinal unit in a district general hospital. Br J Anaesth, 2003, 90(4): 474-479.
26.	Petrucci N, Iacovelli W. Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004, (2): CD003844.
27.	Shneerson JM. Techniques in mechanical ventilation: principles and practice. Thorax, 1996, 51(7): 756-761.
28.	Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth, 2002, 89(4): 622-632.
29.	Kita T, Mammoto T, Kishi Y. Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma. J Clin Anesth, 2002, 14(4): 252-256.
30.	Chau EH, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth, 2014, 18(1): 36-44.
31.	Giglio MT, Marucci M, Testini M, et al. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth, 2009, 103(5): 637-646.
32.	Kimberger O, Arnberger M, Brandt S, et al. Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon. Anesthesiology, 2009, 110(3): 496-504.
33.	Yoshida N, Watanabe M, Baba Y, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today, 2014, 44(3): 526-532.
34.	Hawn MT, Houston TK, Campagna EJ, et al. The attributable risk of smoking on surgical complications. Ann Surg, 2011, 254(6): 914-920.

1. Bailey SH, Bull DA, Harpole DH, et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg, 2003, 75(1): 217-222.
2. Karl RC, Schreiber R, Boulware D, et al. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg, 2000, 231(5): 635-643.
3. Ryan AM, Hearty A, Prichard RS, et al. Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy. J Gastrointest Surg, 2007, 11(10): 1355-1360.
4. Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol, 2004, 11(7): 682-689.
5. Law SY, Fok M, Wong J. Risk analysis in resection of squamous cell carcinoma of the esophagus. World J Surg, 1994, 18(3): 339-346.
6. Whooley BP, Law S, Murthy SC, et al. Analysis of reduced death and complication rates after esophageal resection. Ann Surg, 2001, 233(3): 338-344.
7. Takeno S, Takahashi Y, Watanabe S, et al. Esophagectomy in patients aged over 80 years with esophageal cancer. Hepatogastroenterology, 2008, 55(82-83): 453-456.
8. Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol, 2006, 20(2): 265-283.
9. Griffin SM, Shaw IH, Dresner SM. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management. J Am Coll Surg, 2002, 194(3): 285-297.
10. Healy LA, Ryan AM, Gopinath B, et al. Impact of obesity on outcomes in the management of localized adenocarcinoma of the esophagus and esophagogastric junction. J Thorac Cardiovasc Surg, 2007, 134(5): 1284-1291.
11. Brodner G, Pogatzki E, Van Aken H, et al. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg, 1998, 86(2): 228-234.
12. Neal JM, Wilcox RT, Allen HW, et al. Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction. Reg Anesth Pain Med, 2003, 28(4): 328-334.
13. Sato N, Koeda K, Ikeda K, et al. Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg, 2002, 236(2): 184-190.
14. Raimondi AM, Guimarães HP, Amaral JL, et al. Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma. Sao Paulo Med J, 2006, 124(2): 11211-11215.
15. Takeda S, Takeda S, Kim C, et al. Preoperative administration of methylprednisolone attenuates cytokine-induced respiratory failure after esophageal resection. J Nippon Med Sch, 2003, 70(1): 16-20.
16. Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg, 1998, 86(3): 598-612.
17. Cense HA, Lagarde SM, de Jong K, et al. Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection. J Am Coll Surg, 2006, 202(3): 395-400.
18. Casado D, Lopez F, Marti R. Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus, 2010, 23(7): 523-528.
19. Wei S, Tian J, Song X, et al. Association of perioperative fluid balance and adverse surgical outcomes in esophageal cancer and esophagogastric junction cancer. Ann Thorac Surg, 2008, 86(1): 266-272.
20. Kroenke K, Lawrence VA, Theroux JF, et al. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med, 1992, 152(5): 967-971.
21. D'journo XB, Michelet P, Avaro JP, et al. Respiratory complications after oesophagectomy for cancer. Rev Mal Respir, 2008, 25(6): 683-694.
22. Atkins BZ, Fortes DL, Watkins KT. Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk. Dysphagia, 2007, 22(1): 49-54.
23. Nishi M, Hiramatsu Y, Hioki K, et al. Pulmonary complications after subtotal oesophagectomy. Br J Surg, 1988, 75(6): 527-530.
24. Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev, 2016, 2: CD009121.
25. Chandrashekar MV, Irving M, Wayman J, et al. Immediate extubation and epidural analgesia allow safe management in a high-dependency unit after two-stage oesophagectomy. Results of eight years of experience in a specialized upper gastrointestinal unit in a district general hospital. Br J Anaesth, 2003, 90(4): 474-479.
26. Petrucci N, Iacovelli W. Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004, (2): CD003844.
27. Shneerson JM. Techniques in mechanical ventilation: principles and practice. Thorax, 1996, 51(7): 756-761.
28. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth, 2002, 89(4): 622-632.
29. Kita T, Mammoto T, Kishi Y. Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma. J Clin Anesth, 2002, 14(4): 252-256.
30. Chau EH, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth, 2014, 18(1): 36-44.
31. Giglio MT, Marucci M, Testini M, et al. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth, 2009, 103(5): 637-646.
32. Kimberger O, Arnberger M, Brandt S, et al. Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon. Anesthesiology, 2009, 110(3): 496-504.
33. Yoshida N, Watanabe M, Baba Y, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today, 2014, 44(3): 526-532.
34. Hawn MT, Houston TK, Campagna EJ, et al. The attributable risk of smoking on surgical complications. Ann Surg, 2011, 254(6): 914-920.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of perioperative fluid management on postoperative pulmonary complications of esophagectomy: A retrospective cohort study

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