Intraoperative fluid rate and postoperative complications for pancreatoduodenectomy

With the advent of enhanced recovery after surgery protocols, there has been a trend toward restricted fluid management for pancreatic surgery. We hypothesized that restricted fluid administration would be associated with reduced postoperative complications and shorter hospital length of stay for patients treated with pancreatoduodenectomy (PD).

This study used a retrospective study design evaluating patients treated with a PD at a large, single institution from 2004 to 2024. Patients were stratified by total intraoperative fluid administration (colloid and crystalloid): <500 mL/h (low fluid group) or ≥500 mL/h (high fluid group). Notably, 1:1 nearest neighbor propensity score matching was performed, matching on receipt of neoadjuvant chemotherapy, pathologic diagnosis, estimated blood loss (EBL), and technical aspects (minimally invasive and/or pylorus preservation).

Of 933 patients undergoing PD, 542 received <500 mL/h of intraoperative fluids (low fluids) and 391 received ≥500 mL/h (high fluids). High fluid administration was associated with more complex procedures, including increased vascular resections (8.7% vs 5.2%; P =.045) and higher EBL (200 [75-475] mL vs 75 [25-165] mL; P <.001). Among patients with cancer, the high fluid group more often had positive margins (14.0% vs 9.6%; P =.03). After propensity score matching, overall complication rates were not significantly different, but the high fluid group experienced slower return of bowel function (liquids, 3 [1-4] vs 2 [1-3]; P <.001; solids, 5 [3-6] vs 4 [2-5]; P =.002).

High fluid administration (≥500 mL/h) during PD was associated with delayed return of bowel function without an increase in complication risk. This finding might support the restricted delivery of fluids in PD.