Fluid Restrictions May Cut Post-Op Complications in Pancreaticoduodenectomy
(HealthDay News) — For patients undergoing pancreaticoduodenectomy (PD), fluid restrictions with 3% hypertonic saline can significantly cut complication rates, according to a study published in the September issue of the Annals of Surgery.
Harish Lavu, MD, from Thomas Jefferson University in Philadelphia, and colleagues randomized 264 patients undergoing PD to receive either lactated ringers (LAR; 15ml/kg/hour LAR intraoperatively, 2ml/kg/hour LAR postoperatively) or hypertonic saline 3% (HYS; 9ml/kg/hour LAR and 1ml/kg/hour HYS intraoperatively, 1 ml/kg/hour HYS postoperatively).
The researchers found that HYS patients had a significantly reduced net fluid balance (P=0.02), as well as a reduced rate of overall complications (43 vs. 54%), with a relative risk of 0.79 (95% confidence interval, 0.62–1.02; P=0.073). The relative risk was 0.75 (95% confidence interval, 0.58–0.96; P=0.023) after adjusting for age and weight. The HYS group had a significant reduction in the total number of complications (93 vs. 123), with an incidence rate ratio of 0.74 (P=0.027), which was further reduced to 0.69 (P=0.0068) after adjustment for age and weight. The groups were similar with regards to reoperations, length of stay, readmissions, and 90-day mortality.
"A moderately restrictive fluid regimen with HYS resulted in a statistically significant 25 percent reduction in complications when adjusted for age, weight and pancreatic texture," the authors write.