Background: Restrictive intraoperative fluid management is increasingly recommended for patients undergoing\nesophagectomy. Controversy still exists about the impact of postoperative fluid management on perioperative outcome.\nMethods: We retrospectively examined 335 patients who had undergone esophagectomy for esophageal cancer at the\nUniversity Hospital Freiburg between 1996 and 2014 to investigate the relation between intra- and postoperative fluid\nmanagement and postoperative morbidity after esophagectomy.\nResults: Perioperative morbidity was 75%, the in-hospital mortality 8%. A fluid balance above average on the operation\nday was strongly associated with a higher rate of postoperative mortality (21% vs 3%, p < 0.001) and morbidity (83% vs\n66%, p = 0.001). Univariate analysis for risk factors for adverse surgical outcome (Clavien � III) identified ASA-score\n(p = 0.002), smoking (p = 0.036), reconstruction by colonic interposition (p = 0.036), cervical anastomosis (p = 0.017),\nblood transfusion (p = 0.038) and total fluid balance on the operation day and on POD 4 (p = 0.001) as risk factors.\nMultivariate analysis confirmed only ASA-score (p = 0.001) and total fluid balance (p = 0.001) as independent predictors of\nadverse surgical outcome.\nConclusion: Intra- and postoperative fluid overload is strongly associated with increased postoperative morbidity. Our\nresults suggest restrictive intra- and especially postoperative fluid management to optimize the outcome after\nesophagectomy.
Loading....