title: The drowning whipple: perioperative fluid balance and outcomes following pancreaticoduodenectomy.
abstract: OBJECTIVE
  Given the high incidence of postoperative morbidity following pancreaticoduodenectomy (PD), efforts at improving patient outcomes are vital. We sought to determine the impact of perioperative fluid balance on outcomes following PD in order to identify a targeted strategy for reducing morbidity.
  
  
  METHODS
  A retrospective review of consecutive PDs from 2008 to 2012 was completed. Cumulative fluid balances were recorded at 0, 24, 48, and 72 hr postoperatively and patients were divided into quartiles. Multivariate analyses were performed accounting for age, gender, diagnosis, ASA class, estimated blood loss, colloid and blood product use, and hemoglobin nadir. The predefined primary outcome measures were 90-day morbidity (Clavien grade ≥ III), mortality, and hospital readmission.
  
  
  RESULTS
  One hundred sixty-nine PDs were performed during the study period. The 90-day morbidity and mortality rates for the cohort were 40.2% and 3.0%, respectively, while hospital length of stay was 13.6 ± 6.7 days (mean ± SD). Higher fluid balance at 48 and 72 hr postoperatively was an independent predictor of morbidity and length of stay on multivariate analysis.
  
  
  CONCLUSIONS
  Higher postoperative fluid balance is associated with increased postoperative morbidity and longer hospital stay following PD. Efforts at maintaining a fluid-restrictive strategy should be emphasized in this population.
authors.affiliation: Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Department of Surgery, Grand Rapids, Michigan.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Wright
authors.forename: Tracy J
authors.initials: TJ
authors.lastname: Koehler
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D059035:Perioperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
keywords: fluid overload; morbidity; pancreaticoduodenectomy; surgical outcomes