Calculating Intraoperative Fluid Deficit to Prevent Abdominal Compartment Syndrome in Hip Arthroscopy

Area of Science:

• Orthopedic Surgery
• Surgical Complications
• Critical Care Medicine

Background:

• Abdominal compartment syndrome (ACS) is a rare but life-threatening complication following hip arthroscopy.
• Fluid extravasation into the retroperitoneal and intraperitoneal spaces, often via the psoas tunnel, is the primary cause.
• Risk factors include female sex, iliopsoas tenotomy, high pump pressure, and prolonged operative time.

Purpose of the Study:

• To introduce an objective method for measuring intraoperative fluid deficit during hip arthroscopy.
• To provide an early warning system for the potential development of abdominal compartment syndrome (ACS).

Main Methods:

• Monitoring intraoperative fluid output from suction devices (canisters, puddle vacuums, mats).
• Calculating the fluid deficit by subtracting total output from arthroscopic fluid bag intake.
• Implementing a threshold of 1500 mL fluid deficit to trigger increased abdominal monitoring.

Main Results:

• The proposed technique offers an objective measure of intra-abdominal fluid extravasation.
• A fluid deficit exceeding 1500 mL prompts vigilant monitoring for ACS signs like abdominal distension, hypotension, and hypothermia.
• This method aids in the early detection of ACS during hip arthroscopy.

Conclusions:

• The presented fluid deficit monitoring technique provides an objective approach to detect intra-abdominal fluid extravasation during hip arthroscopy.
• Early identification of ACS through this method can improve patient outcomes.
• This technique, despite limitations, serves as a valuable tool for surgical teams managing hip arthroscopy patients.