title: Postoperative fluid overload is a risk factor for adverse surgical outcome in patients undergoing esophagectomy for esophageal cancer: a retrospective study in 335 patients.
abstract: BACKGROUND
  Restrictive intraoperative fluid management is increasingly recommended for patients undergoing esophagectomy. Controversy still exists about the impact of postoperative fluid management on perioperative outcome.
  
  
  METHODS
  We retrospectively examined 335 patients who had undergone esophagectomy for esophageal cancer at the University Hospital Freiburg between 1996 and 2014 to investigate the relation between intra- and postoperative fluid management and postoperative morbidity after esophagectomy.
  
  
  RESULTS
  Perioperative morbidity was 75%, the in-hospital mortality 8%. A fluid balance above average on the operation day was strongly associated with a higher rate of postoperative mortality (21% vs 3%, p < 0.001) and morbidity (83% vs 66%, p = 0.001). Univariate analysis for risk factors for adverse surgical outcome (Clavien ≥ III) identified ASA-score (p = 0.002), smoking (p = 0.036), reconstruction by colonic interposition (p = 0.036), cervical anastomosis (p = 0.017), blood transfusion (p = 0.038) and total fluid balance on the operation day and on POD 4 (p = 0.001) as risk factors. Multivariate analysis confirmed only ASA-score (p = 0.001) and total fluid balance (p = 0.001) as independent predictors of adverse surgical outcome.
  
  
  CONCLUSIONS
  Intra- and postoperative fluid overload is strongly associated with increased postoperative morbidity. Our results suggest restrictive intra- and especially postoperative fluid management to optimize the outcome after esophagectomy.
authors.affiliation: Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany. Torben.Glatz@uniklinik-freiburg.de.
authors.forename: Torben
authors.identifier: http://orcid.org/0000-0003-3404-2711
authors.initials: T
authors.lastname: Glatz
authors.affiliation: Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.affiliation: Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany.
authors.forename: Goran
authors.initials: G
authors.lastname: Marjanovic
authors.affiliation: Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany.
authors.forename: Svenja
authors.initials: S
authors.lastname: Bregenzer
authors.affiliation: Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
authors.affiliation: Department of General and Visceral Surgery, Medical Center - University of Freiburg and Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Hoeppner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Adverse surgical outcome; Esophageal cancer; Esophagectomy; Morbidity; Perioperative fluid management