Positive fluid balance is associated with complications after elective open infrarenal abdominal aortic aneurysm repair.
BACKGROUND
Open abdominal aortic aneurysm (AAA) repair is associated with cardiac and respiratory complications and an overall mortality rate of 2 to 8%. We hypothesised that excessive fluid administration during the perioperative period contributes to complications and poor outcome after AAA repair.


METHODS
This was a retrospective cohort study. Medical records were analysed for fluid balance and complications in 100 consecutive patients treated by open AAA repair at a single centre between 2002-2005. Mortality and all major adverse events (MAE) such as myocardial infarction (MI), cardiac arrhythmia (Arr), pulmonary oedema (PO), pulmonary infection (PI), and acute renal failure (ARF) were included in the analysis. Level of care and hospital stay, were also recorded.


RESULTS
There were no in-hospital deaths. MAE occurred in 40/100 (40%): MI (6%); Arr (14%); PO (14%); PI (25%); ARF (8%). Complications were not predicted by preoperative cardiovascular risk factors, operative and clamp time, or blood loss. Patients with complications had significantly greater cumulative positive fluid balance on postoperative day 0 (p<0.01), day 1 (p<0.05), day 2 (p<0.03) and day 3 (p<0.04). This relationship also existed for individual complications such as MI, and pulmonary oedema. These patients had significantly longer ICU/HDU (p<0.002) and hospital stay (p<0.0001).


CONCLUSIONS
Serious complications are common after elective open AAA repair, and we have shown that positive fluid balance is predictive of major adverse events increased HDU/ICU and overall hospital stay.
McArdle
G T
GT
Regional Vascular Surgery Unit, Royal Victoria Hospital Belfast, Grosvenor Road, Belfast BT12 6BA, United Kingdom.
Price
G
G
Lewis
A
A
Hood
J M
JM
McKinley
A
A
Blair
P H
PH
Harkin
D W
DW
D058186:Acute Kidney Injury / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D017558:Elective Surgical Procedures; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011654:Pulmonary Edema / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance