title: Intraoperative Fluid Excess Is a Risk Factor for Pancreatic Fistula after Partial Pancreaticoduodenectomy.
abstract: Background. After pancreaticoduodenectomy (PD), pancreatic fistulas (PF) are a frequent complication. Infusions may compromise anastomotic integrity. This retrospective analysis evaluated associations between intraoperative fluid excess and PF.Methods. Data on perioperative parameters including age, sex, laboratory findings, histology, infusions, surgery time, and occurrence of grade B/C PF was collected from all PD with pancreaticojejunostomy (PJ) performed in our department from 12/2011 till 02/2015. The glomerular filtration rate (GFR), infusion rate, and the ratio of both and its association with PF were calculated. ROC analysis was employed to identify a threshold.Results. Complete datasets were available for 83 of 86 consecutive cases. Median age was 66 years (34-84; 60% male), GFR was 93 mL/min (IQR 78-113), and surgery time was 259 min (IQR 217-307). Intraoperatively, 13.6 mL/min (7-31) was infused. In total,n= 18 (21%) PF occurred. When the infusion : GFR ratio exceeded 0.15, PF increased from 11% to 34% (p= 0.0157). No significant association was detected for any of the other parameters.Conclusions. This analysis demonstrates for the first time an association between intraoperative fluid excess and PF after PD with PJ even in patients with normal renal function. A carefully patient-adopted fluid management with due regard to renal function may help to prevent postoperative PF.
authors.affiliation: Department of General and Visceral Surgery, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
authors.forename: Helge
authors.identifier: 0000-0003-1010-1043
authors.initials: H
authors.lastname: Bruns
authors.affiliation: Department of General and Visceral Surgery, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Kortendieck
authors.affiliation: Department of General and Visceral Surgery, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
authors.forename: Hans-Rudolf
authors.initials: HR
authors.lastname: Raab
authors.affiliation: Department of General and Visceral Surgery, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Antolovic