Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

Area of Science:

• Perioperative Medicine
• Surgical Outcomes Research
• Fluid Management Strategies

Background:

• Optimal fluid management is crucial for patients undergoing open colorectal surgery.
• Postoperative complications, including respiratory issues and ileus, are common.
• Identifying critical fluid thresholds can improve patient outcomes.

Purpose of the Study:

• To analyze fluid management practices in elective open colorectal surgery.
• To define optimal fluid-related thresholds associated with postoperative complications.
• To identify risk factors for adverse outcomes in this patient population.

Main Methods:

• Retrospective analysis of 121 patients undergoing elective open colorectal resections.
• Outcomes assessed included overall and severe complications (Clavien classification), respiratory complications, and postoperative ileus (POI).
• Receiver operator characteristic (ROC) analysis identified critical thresholds for fluid administration and weight gain; multivariable logistic regression identified risk factors.

Main Results:

• 69% of patients experienced complications, with 21% having severe complications.
• Thresholds identified: 3.5 L of intravenous fluids on postoperative day (POD) 0 and 3.5 kg weight gain on POD 2.
• Weight gain >3.5 kg at POD 2 was a significant risk factor for overall complications (OR 5.9).

Conclusions:

• A postoperative weight gain exceeding 3.5 kg by POD 2 is a critical threshold for overall complications, respiratory issues, and prolonged length of stay.
• Fluid management and monitoring weight gain are essential for optimizing outcomes in open elective colorectal surgery.