Fluid administration and morbidity in transhiatal esophagectomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Critical Care Medicine

Background:

• Esophagectomy carries substantial morbidity.
• Optimizing perioperative fluid management may reduce complications.
• Malnourished patients may be more susceptible to fluid overload.

Purpose of the Study:

• To investigate the association between intraoperative fluid (IOF) administration and outcomes in transhiatal esophagectomy patients.
• To specifically examine the impact of malnutrition on fluid management and outcomes.

Main Methods:

• Retrospective analysis of 211 transhiatal esophagectomy patients (2000-2013).
• Intraoperative fluid rates (mL/kg/hr) were calculated and compared to outcomes.
• Patients stratified by median preoperative serum albumin (≤3.7 g/dL vs. >3.7 g/dL) to assess malnutrition impact.

Main Results:

• Increased IOF rate was significantly associated with length of stay, complications per patient, and major complications.
• Linear regression identified IOF rate as a predictor of adverse outcomes.
• Patients with lower albumin levels receiving above-median IOF experienced more severe complications.

Conclusions:

• Higher intraoperative fluid administration correlates with increased perioperative morbidity in esophagectomy.
• Preoperative nutritional status, indicated by albumin levels, influences patient sensitivity to fluid overload.