title: Perioperative fluid infusion and its influence on anastomotic leakage after rectal cancer surgery: implications for prevention strategies.
abstract: OBJECTIVE
  This study aimed to identify modifiable risk factors for anastomotic leakage during the postoperative period to recognize areas of clinical practice that could be improved.
  
  
  METHODS
  Medical charts of patients who underwent elective open anterior resection for rectal cancer over a 5-year period were reviewed retrospectively.
  
  
  RESULTS
  One hundred and twenty-four patients [64 men, mean age (± SD) 68.0 ± 9.0 years] underwent an anterior resection for rectal cancer during the study period. Twenty-two (17.7%) patients had anastomotic leakage. Patients who were given more than 8000 ml of intravenous fluid during the 72-h perioperative period had a statistically significant increased risk of developing anastomotic leakage [odds ratio (OR) 3.20, 95% confidence interval (CI) 1.10-9.31, P = 0.049] and the risk increased further when patients were given more than 8500 ml of intravenous fluid (OR 3.86, 95% CI 1.29-11.5, P = 0.019). The incidence of anastomotic leakage was not influenced by baseline comorbidity or tumour stage.
  
  
  CONCLUSIONS
  Perioperative intravenous fluid of more than 8000 ml was associated with increased occurrence of anastomotic leakage. Vigorous monitoring of intravenous fluid use in the perioperative period may minimize this complication.
authors.affiliation: Surgical Research Unit, Herning Regional Hospital, Herning, Denmark.
authors.forename: A K
authors.initials: AK
authors.lastname: Boesen
authors.forename: Y
authors.initials: Y
authors.lastname: Maeda
authors.forename: M
authors.initials: M
authors.lastname: Rørbaek Madsen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000517:prevention & control; D002277:Carcinoma / Q000601:surgery*; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care / Q000706:statistics & numerical data*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Rectal cancer; anastomotic leakage; intravenous fluid; perioperative; prevention