Effects of Intraoperative Fluid Management on Postoperative Outcomes following Lobectomy.

Background. The amount and type of intraoperative fluid in patients with pulmonary resection currently are controversial. This study evaluated the dose-response relationship between intraoperative fluid administration and postoperative outcomes in minimally invasive lobectomy patients. Methods. A retrospective analysis of adult patients undergoing minimally invasive lobectomy between May 2016 and April 2017 was performed. The primary exposure variables were intraoperative total fluid infusion rate and intraoperative colloid infusion rate. The observation outcomes were postoperative pulmonary complications (PPCs), acute kidney injury, in-hospital mortality, postoperative length of stay, and costs. Univariate analyses and multivariate analyses were performed. Results. In 446 patients all resections were minimally invasive lobectomies. Two hundred one PPCs were observed in 172 patients. Binary logistics regression analysis demonstrated that compared with the moderate group of intraoperative total fluid infusion rate, the risk for PPCs was significantly increased at restrictive (odds ratio [OR], 2.202; 95% confidence interval [CI], 1.1894.078; p = 0.012), moderately liberal (OR, 2.743; 95% CI, 1.451-5.184; p = 0.002), and liberal (OR, 2.609; 95% CI, 1.278-5.328; p = 0.008) groups. Compared with the moderate group of intraoperative colloid infusion rate, the risk for PPCs significantly increased at no colloid (OR, 2.095; 95% CI, 1.193-3.680; p = 0.010) and restrictive (OR, 2.911; 95% CI, 1.443-5.873; p = 0.003) groups. Conclusions. In patients undergoing minimally invasive lobectomy the infusion rates of intraoperative total fluid and intraoperative colloid were all significantly associated with PPCs. Both restrictive and liberal intraoperative fluid administration were related to adverse effects on postoperative outcomes. (C) 2019 by The Society of Thoracic Surgeons