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
. 2024 Feb 29;28(1):80-91.
doi: 10.14701/ahbps.23-084. Epub 2024 Jan 12.

Postoperative fluid therapy in enhanced recovery after surgery for pancreaticoduodenectomy

Sharnice Koek  1   2 , Johnny Lo  3 , Rupert Ledger  4 , Mohammed Ballal  1   2
Affiliations

Postoperative fluid therapy in enhanced recovery after surgery for pancreaticoduodenectomy

Sharnice Koek et al. Ann Hepatobiliary Pancreat Surg. .

Abstract

Backgrounds/aims: Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS.

Methods: A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009-2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus).

Results: The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05).

Conclusions: The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.

Keywords: Acute kidney injury; Fluid therapy; Intravenous; Pancreatic cancer; Whipple procedure.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST

Components of this manuscript has been presented at the 2018 International Hepato-Pancreato-Biliary Association World Congress, Geneva Switzerland in 2018 as well as the Asia-Pacific Hepato-Pancreato-Biliary Association Congress in Seoul South Korea in 2019.

Figures

Fig. 1
Fig. 1
Total intravenous fluid administration of (A) chloride and (B) sodium. Values are expressed as mmol per kg on POD 0, 1, and 2. POD, postoperative day; ERAS, enhanced recovery after surgery.
See this image and copyright information in PMC

References

    1. Australian Institute of Health and Welfare (AIHW), author AIHW statistical information system [Internet] AIHW; 2016. [cited 2023 Jul 1]. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents... .
    1. Salem AI, Alfi M, Winslow E, Clifford SC, Weber SM. Has survival following pancreaticoduodenectomy for pancreas adenocarcinoma improved over time? J Surg Oncol. 2015;112:643649. doi: 10.1002/jso.24048. - DOI - PubMed
    1. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–1210. doi: 10.1016/j.gassur.2006.08.018. - DOI - PubMed
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery (ERAS): a review. JAMA Surg. 2017;152:292–298. doi: 10.1001/jamasurg.2016.4952. - DOI - PubMed
    1. Weinberg L, Wong D, Karalapillai D, Pearce B, Tan CO, Tay S, Christophi C, et al. The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenectomy (Whipple's procedure) BMC Anesthesiol. 2014;14:35. doi: 10.1186/1471-2253-14-35. - DOI - PMC - PubMed

LinkOut - more resources