title: Pancreatoduodenectomy and the risk of complications from perioperative fluid administration.
abstract: BACKGROUND
  The dogma of administering sufficient intravenous fluids aggressively to avoid under-resuscitation has recently been challenged. Evidence suggests that excessive perioperative fluid administration may be associated with negative clinical outcomes in gastrointestinal surgery. This study examines the impact of fluid administration on perioperative outcomes in patients undergoing pancreatoduodenectomy (PD).
  
  
  METHODS
  A retrospective analysis of 202 patients undergoing PD between January 2004 and August 2015 was performed. A cut-off value of 10 mL/kg/h was applied (low fluid group: <10 mL/kg/h versus high fluid group: ≥10 mL/kg/h).
  
  
  RESULTS
  There were 76 patients in the low fluid group and 126 patients in the high fluid group. Both groups had comparable age, American Society of Anesthesiologists score and preoperative morbidity rates. Patients in the high fluid group received significantly more total fluids, crystalloids and colloids intraoperatively (P < 0.0001, P < 0.0001 and P = 0.013, respectively) without a significant difference in estimated blood loss (P = 0.586). The net fluid balance on post-operative day 0 was also significantly higher in the high fluid group (P < 0.0001). The mortality rate was 0% in the cohort. Major morbidity rate was 46.1% and 44.4% in low and high fluid groups, respectively (P = 0.836). Reoperation rate was 5.3% for the low fluid group and 1.6% for the high fluid group (P = 0.136). There were no significant differences between the groups for any of the individual complications.
  
  
  CONCLUSIONS
  This study did not identify a difference in post-operative outcomes between the low and high fluid regime in patients undergoing PD.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Preetjote
authors.initials: P
authors.lastname: Gill
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Yeqian
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Shreya
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Mittal
authors.affiliation: Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.|Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Sydney, New South Wales, Australia.|Deparment of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.|Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Samra
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D018281:Cholangiocarcinoma / Q000601:surgery; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019990:Perioperative Care / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies
keywords: complication; fluid; morbidity; pancreatoduodenectomy; perioperative