Crystalloid resuscitation strategies in patients undergoing emergent bowel resection and anastomosis: When enough is enough
Kandagatla P, Fisher CJ, Karamanos E, and Gupta AH. Crystalloid resuscitation strategies in patients undergoing emergent bowel resection and anastomosis: When enough is enough. J Am Coll Surg 2017; 225(4 Suppl 1):S81-S82.
J Am Coll Surg
INTRODUCTION: Anastomotic leaks after bowel resection are a significant source of morbidity and mortality. Different fluid resus-citation strategies after major abdominal operations have been used with varying outcomes. This study hypothesized that aggressive fluid management is associated with higher incidence of anastomotic leaks. METHODS: This was a retrospective study of all patients admitted to a Level I trauma center, undergoing an emergent bowelresection with a primary anastomosis. Variables analyzed included patient demographics, comorbidities, intra-operative fluid resuscitation, use of pressors, and operating room time. Univariate and multivariate analyses were performed. RESULTS: A total of 332 patients were identified, among whom 43 patients (13%) developed a leak. Patients with a leak had a significantly more aggressive fluid resuscitation (18 mL/kg/h vs 12 mL/kg/h, p < 0.01). A liberal fluid resuscitation management (> 15 mL/kg/h) was used in 67.4% of the patients who developed a leak and in 18.0% of the patients who did not (p < 0.01). Resuscitation strategy was independently associated with postoperative leaks in a multivariate analysis (Table). CONCLUSIONS: Increased intraoperative fluid volume resuscitation resulted in a higher incidence of postoperative anastomotic leaks. Using a restricted fluid resuscitation strategy may help prevent postoperative leaks. Further prospective research is warranted.
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