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Restrictive intraoperative fluid intake in liver surgery and postoperative renal function: A propensity score matched
Daniel Eyraud1, Marine Creux2, Diane Lastennet3
1Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France.
Clinics and Research in Hepatology and Gastroenterology
|March 8, 2022
Summary
Liberal fluid intake during liver surgery reduces the risk of postoperative acute kidney injury (AKI) and its severe consequences. Restrictive fluid strategies are a risk factor for AKI, without limiting blood loss.
Area of Science:
- Nephrology
- Hepatobiliary Surgery
- Critical Care Medicine
Background:
- Postoperative acute kidney injury (AKI) is a frequent complication following hepatic surgery.
- While relative hypovolemia is used to minimize blood loss, the impact of restricted fluid administration on AKI is not well understood.
Purpose of the Study:
- To investigate the influence of intraoperative fluid intake strategies on the incidence and consequences of AKI after liver resection.
Main Methods:
- Retrospective analysis of prospectively recorded data from 397 liver resection patients.
- Comparison of restrictive (≤ 5 mL/kg/h) versus liberal (> 5 mL/kg/h) intraoperative fluid therapy.
- Propensity score matching and Cox frailty model used to analyze the association between fluid strategy and AKI.
Main Results:
- Postoperative AKI occurred in 133 patients.
- A liberal fluid strategy was significantly associated with a lower risk of AKI (HR 0.40 [0.29; 0.56], P<0.001) after propensity score matching.
- Patients with AKI experienced longer hospital stays and higher mortality; no increased blood loss was observed with liberal fluid intake.
Conclusions:
- Restrictive intraoperative fluid intake is a risk factor for postoperative AKI in liver surgery.
- Liberal fluid administration does not increase blood loss and is associated with reduced AKI incidence and severity.
- Optimizing fluid management is crucial for improving outcomes in patients undergoing hepatic surgery.
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