Association between perioperative fluid balance and postoperative complications in high-risk abdominal surgery: a single-center retrospective cohort study

The objective was to evaluate the association between the changes in perioperative cumulative fluid balance and the incidence of severe complications in both emergency and elective high-risk abdominal surgery.

Materials and methods. A retrospective cohort study was conducted in the intensive care unit (ICU) of a tertiary multidisciplinary hospital. Inclusion criteria were age >18 years and ICU admission after laparotomy. Cumulative fluid balance (CFB) and percent fluid overload (PFO) were recorded during the first five postoperative days. The primary endpoint was the incidence of Clavien – Dindo grade IIIB–V complications within 90 days. Multivariate logistic regression analysis was performed.

Results. Totally, 147 patients were included. The overall complication rate was 85 %; the rate of life-threatening complications (Clavien – Dindo grade IIIB–V) was 32 %, and mortality was 22.4 %. Multivariate analysis revealed that increased CFB and PFO at the end of the first postoperative day were independent predictors of life-threatening complications: adjusted odds ratio (OR) for CFB was 1.31 (95% CI 1.07–1.60; p = 0.01) per 1 L; for PFO, it was 1.17 (95% CI 1.05–1.32; p = 0.005) per 1%. The PFO index demonstrated robustness to extreme values, confirmed by bootstrap analysis with bias correction (bias-corrected and accelerated 95% CI 1.02–1.33). Analysis of the predicted probability plot identified threshold values associated with a significantly increased risk: cumulative balance > 6 L (OR 3.8; 95% CI 1.3–10.3; p=0.013) and PFO > 8 % (OR 3.3; CI_95% 1.3–8.4; p = 0.011).

Conclusions. In patients undergoing emergency and elective high-risk abdominal surgery, the development of life-threatening complications is associated with a magnitude of the positive perioperative fluid balance. PFO > 8 % by the end of the first postoperative day may be considered as a clinical trigger for the de-escalation of fluid therapy, transition to complex monitoring of overhydraion, and/or initiation of the deresuscitation.

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