Population-based Assessment of Intraoperative Fluid Administration Practices Across Three Surgical Specialties

被引:23
作者
Regenbogen, Scott E. [1 ,3 ,4 ]
Shah, Nirav J. [2 ]
Collins, Stacey D. [4 ]
Hendren, Samantha [1 ,3 ,4 ]
Englesbe, Michael J. [1 ,4 ]
Campbell, Darrell A., Jr. [4 ]
机构
[1] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Dept Anesthesia, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Ctr Healthcare Outcomes & Policy, Ann Arbor, MI 48109 USA
[4] Michigan Surg Qual Collaborat, Ann Arbor, MI USA
关键词
enhanced recovery; fluid resuscitation; outcomes; surgery; ENHANCED-RECOVERY; MYOCARDIAL-INFARCTION; HEMODYNAMIC PREDICTORS; COLORECTAL SURGERY; NONCARDIAC SURGERY; COLONIC SURGERY; HOSPITAL STAY; APGAR SCORE; MANAGEMENT; OUTCOMES;
D O I
10.1097/SLA.0000000000001745
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To assess the variation in hospitals' approaches to intraoperative fluid management and their association with postoperative recovery. Background: Despite increasing interest in goal-directed, restricted-volume fluid administration for major surgery, there remains little consensus on optimal strategies, due to the lack of institution-level studies of resuscitation practices. Methods: Among 64 hospitals in a state-wide surgical collaborative, we profiled fluid administration practices during 8404 intestinal resections, 22,854 hysterectomies, and 1471 abdominopelvic endovascular procedures. We computed intraoperative fluid balance, accounting for patient morphometry, crystalloid, colloid, blood products, urine, blood loss, duration, and approach. We stratified hospitals by average fluid balance quartile, and compared patterns across disciplines and associations with risk-adjusted postoperative length of stay (pLOS). Results: There was wide variation in fluid balance between hospitals (P < 0.001, all procedures), but significant within-hospital correlation across operations (Pearson rho: intestinal-hysterectomy = 0.50, intestinal-endovascular = 0.36, hysterectomy-endovascular = 0.54, all P < 0.05). Highest fluid balance hospitals had significantly longer adjusted pLOS than lowest balance hospitals for intestinal resection (6.5 vs 5.7 d, P < 0.001) and hysterectomy (1.9 vs 1.7 d, P < 0.001), but not endovascular (2.1 vs 2.3 d, P = 0.69). Risk-adjusted complication rates were not associated with fluid balance rankings. Conclusions: Hospitals' approaches to intraoperative fluid administration vary widely, and their practice patterns are pervasive across disparate procedures. High fluid balance hospitals have 12% to 14% longer risk-adjusted pLOS for visceral abdominal surgery, independent of patient complexity and complications. These findings are consistent with evidence that isovolemic resuscitation in enhanced recovery protocols accelerates recovery of bowel function.
引用
收藏
页码:930 / 940
页数:11
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