Ultrarestrictive intraoperative intravenous fluids during pancreatoduodenectomy is not associated with an increase in post-operative acute kidney injury - 20/06/20

Doi : 10.1016/j.amjsurg.2020.03.021

Zayan Mahmooth ^a, Mohammad Raheel Jajja ^a,^b, Daniel Maxwell ^a, Anyul Ferez-Pinzon ^c, Juan M. Sarmiento ^a,^b,^⁎
^a Emory University, Department of Surgery, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA
^b Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, 30322, USA
^c Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, 30322, USA

^∗Corresponding author. Emory University, Department of Surgery, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA.Emory UniversityDepartment of Surgery1364 Clifton Rd NEAtlantaGA30322USA

Abstract

Background

The amount of IV fluids sufficient to prevent post-operative acute kidney injury (AKI) during pancreaticoduodenectomy (PD) is unknown. We assessed the restrictive IOIVF use in PD on the rate of post-operative AKI, delayed gastric emptying and ileus, and pancreatic fistulas (POPF).

Methods

Patients who underwent PD between 2012 and 2017 were reviewed. Univariate and multivariate analyses looked for association between pre- and intra-operative factors on AKI, ileus and POPF.

Results

Of 395 included patients, 97, 172, and 126 patients received less than 1000 mL (ultra-restrictive), 1000 mL to less than 2000 mL (restrictive), and 2000 mL and greater (nonrestrictive) normalized total IOIVF respectively. Of these 23 (24.2%), 34(20.4%), and 21(17.4%) developed AKI respectively, most of them mild. There was no difference in odds of developing AKI, ileus, or pancreatic fistula among fluid groups. While there was no difference in Clavien-Dindo III-IV complications, the incidence of Clavien-Dindo type I-II complications was lower in the restricted fluid groups.

Discussion

Restricted fluids did not lead to higher AKI rates but were associated with fewer low-grade complications.

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Highlights

•	Restrictive intra-operative fluids did not increase post-operative AKI rates.
•	Restrictive fluids associated with reduced Clavien-Dindo I-II complications.
•	Longer length of surgery associated with post-operative acute kidney injury.

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Keywords : Pancreatoduodenectomy, Pancreaticoduodenectomy, Whipple, Acute kidney injury, Pancreas surgery