Fluid management for critical patients undergoing urgent colectomy

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Fluid Management

Background:

• Urgent colectomies carry significant risks of postoperative complications.
• Optimizing perioperative fluid balance and monitoring weight changes are crucial for patient recovery.

Purpose of the Study:

• To define critical thresholds for perioperative fluid administration and postoperative weight gain after urgent colectomies.
• To identify fluid and weight gain thresholds associated with adverse outcomes.

Main Methods:

• Analysis of consecutive urgent colectomies within an enhanced recovery pathway (2011-2017).
• Utilized receiver operating characteristic (ROC) analysis to identify thresholds for fluid administration and weight gain.
• Multivariable logistic regression identified independent predictors of postoperative complications.

Main Results:

• A threshold of 3 L of intravenous fluid on the day of surgery was associated with increased overall complications (OR 5.33).
• A postoperative weight gain of 2.3 kg by postoperative day 2 was also an independent predictor of complications (OR 2.5).
• Patients exceeding these thresholds experienced significantly longer hospital stays.

Conclusions:

• Fluid administration of 3 L on surgery day and a 2.3 kg weight gain by postoperative day 2 may serve as critical thresholds for adverse outcomes.
• These identified thresholds require independent validation to confirm their clinical utility in managing patients undergoing urgent colectomy.