TY - JOUR
T1 - Fluid management and vasopressor use during colorectal surgery
T2 - the search for the optimal balance
AU - Huisman, Daitlin E.
AU - Bootsma, Boukje T.
AU - Ingwersen, Erik W.
AU - Reudink, Muriël
AU - Slooter, Gerrit D.
AU - Stens, Jurre
AU - Daams, Freek
AU - the LekCheck Study group
AU - Roumen, Rudi M. H. M. H.
AU - van Rooijen, Stefanus J.
AU - Bleeker, Wim
AU - Stassen, Laurents P. S.
AU - Jongen, Audrey
AU - Feo, Carlo V.
AU - Targa, Simone
AU - Komen, Niels
AU - Kroon, Hidde M.
AU - Sammour, Tarik
AU - Lagae, Emmanuel A. G. L.
AU - Talsma, Aalbert K.
AU - Wegdam, Johannes A.
AU - de Vries Reilingh, Tammo S.
AU - van Wely, Bob
AU - van Hoogstraten, Marie J.
AU - Sonneveld, Dirk J. A.
AU - Verdaasdonk, Emiel G. G.
N1 - Funding Information: This work received support from European Association for Endoscopic Surgery and other Interventional Techniques (2019 Research Grant). Funding Information: LekCheck Study group: Rudi M.H. Roumen MD PhD, Department of Anesthesiology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Stefanus J. van Rooijen MD PhD, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands; Wim Bleeker MD, Department of Surgery, Wilhelmina Ziekenhuis, Assen, The Netherlands; Laurents P.S. Stassen Prof Dr MD PhD, Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Audrey Jongen MD PhD, Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Carlo V. Feo MD FACS, Department of Surgery, Ospedale del Delta, Lagosanto, Ferrara, Italy; Simone Targa MD, Department of Surgery, Ospedale del Delta, Lagosanto, Ferrara, Italy; Niels Komen MD PhD, Department of Surgery, Antwerp University Hospital, Antwerp, Belgium; Hidde M. Kroon MD PhD, Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia; Tarik Sammour MBCHB PhD FRACS, Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia; Emmanuel A.G.L. Lagae MD, Department of Surgery, ZorgSaam, Terneuzen, The Netherlands; Aalbert K. Talsma MD, Department of Surgery, Deventer Ziekenhuis, Deventer, The Netherlands; Johannes A. Wegdam MD, Department of Surgery, Elkerliek Ziekenhuis, Helmond, The Netherlands; Tammo S. de Vries Reilingh MD, Department of Surgery, Elkerliek Ziekenhuis, Helmond, The Netherlands; Bob van Wely MD, Department of Surgery, Bernhoven, Uden, the Netherlands; Marie J. van Hoogstraten MD, Department of Surgery, Bernhoven, Uden, the Netherlands; Dirk J.A. Sonneveld MD, Department of Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands; Emiel G.G. Verdaasdonk MD, Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands. Publisher Copyright: © 2023, The Author(s).
PY - 2023/8
Y1 - 2023/8
N2 - Background: Although it is known that excessive intraoperative fluid and vasopressor agents are detrimental for anastomotic healing, optimal anesthesiology protocols for colorectal surgery are currently lacking. Objective: To scrutinize the current hemodynamic practice and vasopressor use and their relation to colorectal anastomotic leakage. Design: A secondary analysis of a previously published prospective observational study: the LekCheck study. Study setting: Adult patients undergoing a colorectal resection with the creation of a primary anastomosis. Outcome measures: Colorectal anastomotic leakage (CAL) within 30 days postoperatively, hospital length of stay and 30-day mortality. Results: Of the 1548 patients, 579 (37%) received vasopressor agents during surgery. Of these, 201 were treated with solely noradrenaline, 349 were treated with phenylephrine, and 29 received ephedrine. CAL rate significantly differed between the patients receiving vasopressor agents during surgery compared to patients without (11.8% vs 6.3%, p < 0.001). CAL was significantly higher in the group receiving phenylephrine compared to noradrenaline (14.3% vs 6%, p < 0.001). Vasopressor agents were used more often in patients treated with Goal Directed Therapy (47% vs 34.6%, p < 0.001). There was a higher mortality rate in patients with vasopressors compared to the group without (2.8% vs 0.4%, p = 0.01, OR 3.8). Mortality was higher in the noradrenaline group compared to the phenylephrine and those without vasopressors (5% vs. 0.4% and 1.7%, respectively, p < 0.001). In multivariable analysis, patients with intraoperative vasopressor agents had an increased risk to develop CAL (OR 2.1, CI 1.3–3.2, p = 0.001). Conclusion: The present study contributes to the evidence that intraoperative use of vasopressor agents is associated with a higher rate of CAL. This study helps to create awareness on the (necessity to) use of vasopressor agents in colorectal surgery patients in striving for successful anastomotic wound healing. Future research will be required to balance vasopressor agent dosage in view of colorectal anastomotic leakage.
AB - Background: Although it is known that excessive intraoperative fluid and vasopressor agents are detrimental for anastomotic healing, optimal anesthesiology protocols for colorectal surgery are currently lacking. Objective: To scrutinize the current hemodynamic practice and vasopressor use and their relation to colorectal anastomotic leakage. Design: A secondary analysis of a previously published prospective observational study: the LekCheck study. Study setting: Adult patients undergoing a colorectal resection with the creation of a primary anastomosis. Outcome measures: Colorectal anastomotic leakage (CAL) within 30 days postoperatively, hospital length of stay and 30-day mortality. Results: Of the 1548 patients, 579 (37%) received vasopressor agents during surgery. Of these, 201 were treated with solely noradrenaline, 349 were treated with phenylephrine, and 29 received ephedrine. CAL rate significantly differed between the patients receiving vasopressor agents during surgery compared to patients without (11.8% vs 6.3%, p < 0.001). CAL was significantly higher in the group receiving phenylephrine compared to noradrenaline (14.3% vs 6%, p < 0.001). Vasopressor agents were used more often in patients treated with Goal Directed Therapy (47% vs 34.6%, p < 0.001). There was a higher mortality rate in patients with vasopressors compared to the group without (2.8% vs 0.4%, p = 0.01, OR 3.8). Mortality was higher in the noradrenaline group compared to the phenylephrine and those without vasopressors (5% vs. 0.4% and 1.7%, respectively, p < 0.001). In multivariable analysis, patients with intraoperative vasopressor agents had an increased risk to develop CAL (OR 2.1, CI 1.3–3.2, p = 0.001). Conclusion: The present study contributes to the evidence that intraoperative use of vasopressor agents is associated with a higher rate of CAL. This study helps to create awareness on the (necessity to) use of vasopressor agents in colorectal surgery patients in striving for successful anastomotic wound healing. Future research will be required to balance vasopressor agent dosage in view of colorectal anastomotic leakage.
KW - Colorectal anastomotic leakage
KW - Fluid management
KW - Vasopressors
UR - http://www.scopus.com/inward/record.url?scp=85156156875&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-023-09980-1
DO - https://doi.org/10.1007/s00464-023-09980-1
M3 - Article
C2 - 37126191
SN - 0930-2794
VL - 37
SP - 6062
EP - 6070
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 8
ER -