title: Perioperative fluid status and surgical outcomes in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer.
abstract: OBJECTIVE
  The objective of this study is to investigate the impact of fluid status on perioperative outcomes of patients undergoing cytoreductive surgery (CRS) for advanced epithelial ovarian cancer (EOC).
  
  
  METHODS
  Patients undergoing CRS for stage III or IV EOC at a comprehensive cancer center from 12/2010 to 05/2015 were identified. Those who underwent upper abdominal procedures or colon resections were included. Demographic, perioperative, and 30-day complication data were collected. Perioperative weight change was utilized as a surrogate for fluid status. The time to diuresis (tD) was defined as the postoperative day the patient's weight began to downtrend.
  
  
  RESULTS
  One hundred ten patients were included. Median age was 62years and median BMI 25.8kg/m2. The majority (74.5%) were stage IIIC. At least 1 bowel resection was performed in 60 cases (54.5%). A median of 5381mL of crystalloid (range 1000-17,550mL) and 500mL of colloids (range 0-2783mL) was given intraoperatively. The median perioperative weight change was +7.3kg (range-0.9kg to +35.7kg). The median tD was 3days (range 1-17days). On univariate analysis, net positive fluid status was associated with unscheduled reoperation, anastomotic leak, surgical site infections (SSI), and length of stay >5days. On multivariate analysis, fluid status was independently associated with SSI (p=0.01).
  
  
  CONCLUSIONS
  Perioperative fluid excess is common in patients undergoing CRS for EOC and is independently associated with SSI.
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: mdesale1@jhmi.edu.
authors.forename: M G
authors.initials: MG
authors.lastname: Desale
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: etanner4@jhmi.edu.
authors.forename: E J
authors.initials: EJ
authors.lastname: Tanner
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: asinno2@jhmi.edu.
authors.forename: A K
authors.initials: AK
authors.lastname: Sinno
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: aangari1@jhmi.edu.
authors.forename: A Africano
authors.initials: AA
authors.lastname: Angarita
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: afader1@jhmi.edu.
authors.forename: A N
authors.initials: AN
authors.lastname: Fader
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: rstone15@jhmi.edu.
authors.forename: R L
authors.initials: RL
authors.lastname: Stone
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: klevins1@jhmi.edu.
authors.forename: K L
authors.initials: KL
authors.lastname: Levinson
authors.affiliation: Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California-Irvine, Orange, CA, USA. Electronic address: rbristow@uci.edu.
authors.forename: R E
authors.initials: RE
authors.lastname: Bristow
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA; Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Electronic address: karalong@gmail.com.
authors.forename: K Long
authors.initials: KL
authors.lastname: Roche
keywords: Cytoreductive surgery; Epithelial ovarian cancer; Fluid management; Perioperative