Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Aug;37(8):6062-6070.
doi: 10.1007/s00464-023-09980-1. Epub 2023 May 1.

Fluid management and vasopressor use during colorectal surgery: the search for the optimal balance

Daitlin E Huisman  1 , Boukje T Bootsma  2 , Erik W Ingwersen  2 , Muriël Reudink  3 , Gerrit D Slooter  3 , Jurre Stens  4 , Freek Daams  2 ; LekCheck Study group
Collaborators, Affiliations
Observational Study

Fluid management and vasopressor use during colorectal surgery: the search for the optimal balance

Daitlin E Huisman et al. Surg Endosc. 2023 Aug.

Abstract

Background: Although it is known that excessive intraoperative fluid and vasopressor agents are detrimental for anastomotic healing, optimal anesthesiology protocols for colorectal surgery are currently lacking.

Objective: To scrutinize the current hemodynamic practice and vasopressor use and their relation to colorectal anastomotic leakage.

Design: A secondary analysis of a previously published prospective observational study: the LekCheck study.

Study setting: Adult patients undergoing a colorectal resection with the creation of a primary anastomosis.

Outcome measures: Colorectal anastomotic leakage (CAL) within 30 days postoperatively, hospital length of stay and 30-day mortality.

Results: Of the 1548 patients, 579 (37%) received vasopressor agents during surgery. Of these, 201 were treated with solely noradrenaline, 349 were treated with phenylephrine, and 29 received ephedrine. CAL rate significantly differed between the patients receiving vasopressor agents during surgery compared to patients without (11.8% vs 6.3%, p < 0.001). CAL was significantly higher in the group receiving phenylephrine compared to noradrenaline (14.3% vs 6%, p < 0.001). Vasopressor agents were used more often in patients treated with Goal Directed Therapy (47% vs 34.6%, p < 0.001). There was a higher mortality rate in patients with vasopressors compared to the group without (2.8% vs 0.4%, p = 0.01, OR 3.8). Mortality was higher in the noradrenaline group compared to the phenylephrine and those without vasopressors (5% vs. 0.4% and 1.7%, respectively, p < 0.001). In multivariable analysis, patients with intraoperative vasopressor agents had an increased risk to develop CAL (OR 2.1, CI 1.3-3.2, p = 0.001).

Conclusion: The present study contributes to the evidence that intraoperative use of vasopressor agents is associated with a higher rate of CAL. This study helps to create awareness on the (necessity to) use of vasopressor agents in colorectal surgery patients in striving for successful anastomotic wound healing. Future research will be required to balance vasopressor agent dosage in view of colorectal anastomotic leakage.

Keywords: Colorectal anastomotic leakage; Fluid management; Vasopressors.

PubMed Disclaimer

Conflict of interest statement

DEH is employed by Johnson and Johnson, although her work is not related to the subject of this paper. FD was granted the 2019 EAES research grant for this project. He received a speaker fee from Medtronic. BB, EWI, MR, GDS and JS have no conflicts of interest or financial ties to disclose.

References

    1. Zakrison T, Nascimento BA, Tremblay LN, Kiss A, Rizoli SB. Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage. World J Surg. 2007;31(8):1627–1634. doi: 10.1007/s00268-007-9113-4. - DOI - PubMed
    1. Adanir T, Nazli O, Kara C, Aksun M, Sozutek A, Sencan A, Oktay G. The relationship between vasopressor dose and anastomotic leak in colon surgery: an experimental trial. Int J Surg. 2010;8(3):221–224. doi: 10.1016/j.ijsu.2010.01.004. - DOI - PubMed
    1. Choudhuri AH, Uppal R, Kumar M. Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: audit from a tertiary care teaching institute. Int J Crit Illn Inj Sci. 2013;3(4):246–249. doi: 10.4103/2229-5151.124117. - DOI - PMC - PubMed
    1. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen PE, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F, Danish Study Group on Perioperative Fluid Therapy Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238(5):641–648. doi: 10.1097/01.sla.0000094387.50865.23. - DOI - PMC - PubMed
    1. Cove ME, Pinsky MR. Perioperative hemodynamic monitoring. Best Pract Res Clin Anaesthesiol. 2012;26:453–462. doi: 10.1016/j.bpa.2012.10.003. - DOI - PubMed

Publication types