title: Fluid administration and morbidity in transhiatal esophagectomy.
abstract: BACKGROUND
  Esophagectomy is associated with significant morbidity. Optimizing perioperative fluid administration is one potential strategy to mitigate morbidity. We sought to investigate the relationship of intraoperative fluid (IOF) administration to outcomes in patients undergoing transhiatal esophagectomy with particular attention to malnourished patients, who may be more susceptible to the effects of fluid overload.
  
  
  METHODS
  Patients who underwent transhiatal esophagectomy from 2000-2013 were identified from a retrospective database. IOF rates (mL/kg/hr) were determined and their relationship to outcomes compared. To examine the impact of malnutrition, we stratified patients based on median preoperative serum albumin and compared outcomes.
  
  
  CONCLUSIONS
  211 patients comprised the cohort. 74% of patients underwent esophagectomy for esophageal adenocarcinoma. Linear regression analyses were performed comparing independent perioperative variables to four outcomes variables: length of stay, complications per patient, major complications, and Clavien-Dindo classification. IOF rate was significantly associated with three of four outcomes on univariate analysis. Significantly more patients with a preoperative albumin level ≤3.7 g/dL who received more than the median IOF rate experienced more severe complications.
  
  
  CONCLUSIONS
  Increased intraoperative fluid administration is associated with perioperative morbidity in patients undergoing transhiatal esophagectomy. Patients with lower preoperative albumin levels may be particularly sensitive to the effects of volume overload.
authors: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903.
authors: Oliver S
authors: OS
authors: Eng
authors: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903.
authors: Renee L
authors: RL
authors: Arlow
authors: Department of Biostatistics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.
authors: Dirk
authors: D
authors: Moore
authors: Department of Biostatistics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.
authors: Chunxia
authors: C
authors: Chen
authors: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.
authors: John E
authors: JE
authors: Langenfeld
authors: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.
authors: David A
authors: DA
authors: August
authors: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903. Electronic address: carpizdr@cinj.rutgers.edu.
authors: Darren R
authors: DR
authors: Carpizo
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Fluids; Morbidity; Transhiatal esophagectomy