title: Role of intraoperative fluids on hospital length of stay in laparoscopic bariatric surgery: a retrospective study in 224 consecutive patients.
abstract: BACKGROUND
  Studies are unclear regarding optimal intraoperative fluid management during laparoscopic bariatric surgery. The purpose of this 1-year study was to investigate the role of intraoperative fluid administration on hospital length of stay (hLOS) and postoperative complications in laparoscopic bariatric surgery.
  
  
  METHODS
  Patient data analyzed included previously reported demographics, comorbidities, and intraoperative fluid administration on the duration of hLOS and incidence of postoperative complications.
  
  
  RESULTS
  Logistic regression analysis of demographic and comorbidity variables revealed that BMI (P = 0.0099) and history of anemia (P = 0.0084) were significantly associated with hLOS (C index statistic, 0.7). Lower rates of intraoperative fluid administration were significantly associated with longer hLOS (P = 0.0005). Recursive partitioning observed that patients who received <1,750 ml of intraoperative fluids resulted in longer hLOS when compared to patients who received ≥ 1,750 ml (LogWorth = 0.5). When intraoperative fluid administration rates were defined by current hydration guidelines for major abdominal surgery, restricted rates (<5 ml/kg/h) were associated with the highest incidence of extended hLOS (>1 postoperative day) at 54.1 % when compared to 22.9 % with standard rates (5-7 ml/kg/h) and were lowest at 14.5 % in patients receiving liberal rates (>7 ml/kg/h) (P < 0.0001). Finally, lower rates of intraoperative fluid administration were significantly associated with delayed wound healing (P = 0.03).
  
  
  CONCLUSIONS
  The amount of intravenous fluids administered during laparoscopic bariatric surgery plays a significant role on hLOS and on the incidence of delayed wound healing.
authors.affiliation: Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.
authors.forename: Vaughn E
authors.initials: VE
authors.lastname: Nossaman
authors.affiliation: Department of Surgery, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Richardson
authors.affiliation: Department of Surgery, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Wooldridge
authors.affiliation: Department of Anesthesiology, Section Critical Care Medicine, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA. bnossaman@ochsner.org.
authors.forename: Bobby D
authors.initials: BD
authors.lastname: Nossaman
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology; D050110:Bariatric Surgery; D015992:Body Mass Index; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014945:Wound Healing
keywords: Complications; Fluid management; Hospital length of stay; Laparoscopic bariatric surgery; Obesity; Predictor variables