Influence of different intraoperative fluid management on postoperative outcome after abdominal tumours resection

Abstract

Objectives Intraoperative fluid management is a crucial aspect of cancer surgery, including colorectal surgery and pancreatoduodenectomy. The study tests if intraoperative multimodal monitoring reduces postoperative morbidity and duration of hospitalisation in patients undergoing major abdominal surgery treated by the same anaesthetic protocols with epidural analgesia.

Methods: A prospective study was conducted in 2 parallel groups. High-risk surgical patients undergoing major abdominal surgery were randomly selected in the control group (CG), where standard monitoring was applied (44 patients), and the protocol group (PG), where cerebral oxygenation and hemodynamic monitoring were used with the protocol for intraoperative interventions (44 patients).

Results: There were no differences in the median length of hospital stay, CG 9 days (IQR 8 days), PG 9 (5.5), p= 0.851. There was no difference in postoperative renal of cardiac impairment. Procalcitonin was significantly higher (highest postoperative value in the first 3 days) in CG, 0.75 mcg/L (IQR 3.19mcg/L), than in PG, 0.3 mcg/L (0.88 mcg/L), p= 0.001.  PG patients received a larger volume of intraoperative number; median intraoperative fluid balance +1300 ml (IQR 1063ml) than CG; +375 ml (IQR 438ml), p<0.001.

Conclusions: There was no difference in postoperative morbidity or hospital stay. There were significant differences in intraoperative fluid management and vasopressor use. The median postoperative value of procalcitonin was significantly higher in CG, suggesting differences in immune response to tissue trauma in different intraoperative fluid status.