Intraoperative Fluid Resuscitation Strategies in Pancreatectomy: Results from 38 Hospitals in Michigan.
Fluid administration practices may affect complication rates in some abdominal surgeries, but effects in patients undergoing pancreatectomy are not understood well. We sought to determine whether amount of intraoperative fluid administered to patients undergoing pancreatectomy is associated with postoperative complication rates and to determine whether hospitals vary in their fluid administration practices.



Data for 504 patients undergoing pancreatectomy at 38 hospitals between 2012 and 2015 were evaluated. The main exposure was intraoperative fluid administration (≤10, 10-15, >15 mL/kg/h). Mortality, complications, and length of stay were the main outcomes of interest. Patient-level associations between exposure and outcome were tested, with adjustment for potentially confounding patient and surgical factors, using random intercept, mixed-effects linear or logistic regression models. Hospitals were then categorized as having a restrictive, intermediate, or liberal resuscitation practice, and adjusted outcomes were compared.



A total of 167 (33.1 %), 185 (36.7 %) and 152 (30.2 %) patients received restrictive, intermediate, or liberal fluid administration, respectively. Hospitals with more restrictive practices had significantly lower adjusted 30-day mortality than those with more liberal practices (2.7 vs. 6.6 %; P < 0.001). Hospitals with more restrictive practices had the lowest rates of severe (Grade 2 and 3) complications (15.4 % restrictive vs. 25.3 % intermediate vs. 44.3 % liberal; P < 0.001). More restrictive hospitals had decreased adjusted mean length of stay (9.5 days vs. 12.7 days intermediate vs. 11.6 days liberal; P < 0.001).



More restrictive intraoperative resuscitation practices in pancreatectomy are associated with decreased hospital-level mortality, severe complications, and length of stay.
Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA. healym@umich.edu.
Mark A
MA
Healy
Metro Health Hospital, Wyoming, MI, USA.
Laurence E
LE
McCahill
Spectrum Health Medical Group, Grand Rapids, MI, USA.
Mathew
M
Chung
St. John Providence Hospitals, Grosse Pointe Woods, MI, USA.
Richard
R
Berri
Michigan State University, Lansing, MI, USA.
Hiromichi
H
Ito
Allegiance Health, Jackson, MI, USA.
Shawn H
SH
Obi
Dartmouth Geisel School of Medicine, Hanover, NH, USA.
Sandra L
SL
Wong
Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.
Samantha
S
Hendren
Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
David
D
Kwon
D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality; D011183:Postoperative Complications; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome