title: Impact of fluid resuscitation on major adverse events following pancreaticoduodenectomy.
abstract: BACKGROUND
  Pancreaticoduodenectomy remains a major undertaking with substantial perioperative morbidity and mortality. Previous studies in the colorectal population have noted a correlation between excessive postoperative fluid resuscitation and anastomotic complications. This study sought to assess the relationship between perioperative fluid management and clinical outcomes in patients undergoing pancreaticoduodenectomy.
  
  
  METHODS
  Data from a single institution, prospective database over a 10-year period (2002 to 2012) were reviewed. Patients were compared for perioperative fluid balance and postoperative outcomes. Multivariable analysis was performed to assess the relationship between perioperative fluid administration and incidence of major adverse events.
  
  
  RESULTS
  Higher positive fluid balance on postoperative day 0, postoperative day 1, and postoperative day 2 was associated with increased incidence of major adverse events, increased postoperative intensive care unit admission, and longer hospital stay. Higher positive fluid balance on postoperative day 0 was most strongly associated with postoperative morbidity (odds ratio 1.39, confidence interval 1.16 to 1.66, P = .0003). Fluid balance on postoperative day 3 was not associated with adverse events.
  
  
  CONCLUSIONS
  Increased early perioperative fluid resuscitation is associated with major adverse events in patients undergoing pancreaticoduodenectomy. More restrictive fluid administration may improve postoperative outcomes; further prospective clinical trials focused on fluid resuscitation and goal-directed therapy are needed.
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Ramy
authors.initials: R
authors.lastname: Behman
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Sherif
authors.initials: S
authors.lastname: Hanna
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Coburn
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Cyr
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Truong
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Lam-McCulloch
authors.affiliation: Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: McHardy
authors.affiliation: Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Sawyer
authors.affiliation: Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Idestrup
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: paul.karanicolas@sunnybrook.ca.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Karanicolas
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D016577:Pancreaticoduodenectomy; D010343:Patient Admission / Q000706:statistics & numerical data; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014882:Water-Electrolyte Balance
keywords: Fluid therapy; Pancreatic neoplasms; Pancreaticoduodenectomy; Postoperative complications