Targeted perioperative fluid therapy in enhanced recovery after surgery in pancreaticoduodenectomy

Introduction: Optimal perioperative intravenous fluid regimens in patients undergoing pancreaticoduodenectomy (PD) in the context of enhanced recovery after surgery (ERAS) remains unclear. Studies have suggested total body salt and water excess can lead to oedema and in turn increase morbidity and length of stay. We aimed to evaluate the impact of targeted intravenous therapy on postoperative day (POD) 0 to 2 in patients who underwent a PD in the context of ERAS. Method: A retrospective cohort study of all patients who underwent a PD following ERAS implementation (2012-2017) from the South Metropolitan Health Service, Western Australia were assessed. Patients received a targeted maintenance fluid regimen of 20ml/kg/day with a sodium requirement of 0.5mmol/kg/day. Outcome measures of mmol sodium and chloride administered, length of stay and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus) between the groups were evaluated. Result: 126 patients were included in this study with mean age of 65 ± 11.5 years. In a multivariable analysis, chloride administered (mmol/kg) did not significantly independently impact length of stay, nor did it affect rates of POPF, ileus or AKI (p > 0.05). Conclusion: Our study suggested that a targeted intravenous fluid therapy regime did not impact on morbidity including AKI. A trend to reduction in length of stay is notable in the context of an increasingly comorbid cohort. This targeted regime appears to be safe in patients undergoing PD in the context of ERAS management and deserves further prospective work.