Prospective randomized controlled trial of liberal vs restricted perioperative fluid management in patients undergoing pancreatectomy Journal Article
| Authors: | Grant, F.; Brennan, M. F.; Allen, P. J.; DeMatteo, R. P.; Kingham, T. P.; D'Angelica, M.; Fischer, M. E.; Gonen, M.; Zhang, H.; Jarnagin, W. R. |
| Article Title: | Prospective randomized controlled trial of liberal vs restricted perioperative fluid management in patients undergoing pancreatectomy |
| Abstract: | Objective: The aim of this study is to examine, by a prospective randomized controlled trial, the influence of liberal (LIB) vs restricted (RES) perioperative fluid administration on morbidity following pancreatectomy. Summary of Background Data: Randomized controlled trials in patients undergoing major intra-abdominal surgery have challenged the historical use of LIB fluid administration, suggesting that a more restricted regimen may be associated with fewer postoperative complications. Methods: Patients scheduled to undergo pancreatic resection were consented for randomization to a LIB (n = 164) or RES (n = 166) perioperative fluid regimen. Sample size was designed with 80% power to decrease Grade 3 complications from 35% to 21%. Results: Between July 2009 and July 2015, we randomized 330 patients undergoing pancreaticoduodenectomy (PD, n = 218), central (n = 16), or distal pancreatectomy (DP, n = 96). Patients were equally distributed for all demographic and intraoperative characteristics. Intraoperatively, LIB patients received crystalloid 12 mL/kg/h and RES patients 6 mL/kg/h. Cumulative crystalloid given (median, range, mL) days 0 to 3 was LIB: 12,252 (6600 to 21,365), RES 7808 (2700 to 16,274) P < 0.0001. Sixty-day mortality was 2 of 330 (0.6%). Median operative time for PD was 227 minutes (105 to 462) and DP 150 (44 to 323). Grade 3 complications occurred in 20% of LIB and 27% of RES patients (P = 0.6). Median length of stay was 7 and 5 days for PD and DP, respectively, in both arms. Conclusions: In a high volume institution, major perioperative complications from pancreatic resection were not significantly influenced by fluid regimens that differed approximately 1.6-fold. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | randomized controlled trial; pancreatectomy; fluid management |
| Journal Title: | Annals of Surgery |
| Volume: | 264 |
| Issue: | 4 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2016-10-01 |
| Start Page: | 591 |
| End Page: | 598 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000001846 |
| PROVIDER: | scopus |
| PMCID: | PMC5017901 |
| PUBMED: | 27355261 |
| DOI/URL: | |
| Notes: | Conference Paper -- Export Date: 3 October 2016 -- Source: Scopus |
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