Impact of postoperative intravenous fluid administration on complications following elective hepato-pancreato-biliary surgery

Background: The impact of perioperative intravenous fluid administration on surgical outcomes has been documented in literature, but not specifically studied in the context of hepato-pancreato-biliary(HPB) surgery. This study aimed to investigate the impact of postoperative intravenous fluid administration on intensive care unit(ICU), in this subgroup of patients. Methods: A single-center retrospective cohort of 241 HPB patients was assessed, focusing on intravenous fluid administration in ICU, during the first 24 h. Intravenous fluid variables were compared to hospital stay and postoperative complications. Data were assessed using Spearman's correlation test for bivariate correlations and logistic regression for multivariate analysis. Results: The median volume of intravenous fluid administered in the first 24 h postoperatively was 4380 mL, of which 2200 mL was crystalloid, 1500 mL colloid and 680 mL "other" fluid. Patients with one or more complications had a higher median total intravenous fluid input(4790 vs. 4300 mL), higher colloid volume(20 0 0 vs. 150 0 mL), lower urine output(1595 vs. 1900 mL) and greater overall fluid balance( + 3040 vs. + 2553 mL) than those without complications. There were correlations between total intravenous fluid volume administered( r = 0.278, P < 0.001), intravenous colloid input( r = 0.278, P < 0.001), urine output( r =-0.295, P < 0.001), positive fluid balance( r = 0.344, P < 0.001) and length of hospital stay. Logistic regression model was constructed to predict the occurrence of one or more complications; total intravenous fluid volume and overall fluid balance were both independent significant predictors(OR = 2.463, P = 0.007; OR = 1.001, P = 0.011; respectively). Conclusions: Administration of high volumes of intravenous fluids in the first 24 hours post-HPB surgery, along with higher positive fluid balance is associated with a higher rate of complications and longer hospital stay. Moreover, lower urine output is associated with longer hospital stay. Whether these are the cause of complications or the result of them remains unclear.

The 8th World Congress of International Hepato-Pancreato-Biliary Association

Date： February 27-March 2, 2008 Venue： Renaissance Mumbai Hotel and Convention Centre Website： http：//www.ihpba2008.com/The 8th World Congress of International Hepato-Pancreato-Biliary Association （IHPBA） will be held from February 27 to March 2, 2008, in Mumbai, India. The four-day conference will be the largest international, interdisciplinary forum. The conference is designed for surgeons, minimal access surgeons, gastroenterologists, hepatologists, oncologists, basic scientists, pathologists, anaesthetists and allied health professionals with interest in the management of diseases affecting the liver, biliary tree and pancreas.

Liver transplantation for non-resectable colorectal liver metastases

At present,there are no absolute practice guidelines for liver transplants in colorectal liver metastases(CRLM),and treatment protocols for unresectable CRLM are institution-specific(1).One of the first prospective studies evaluating the safety of liver transplants for CRLM was the SECA-I trial(1,2).A 5-year overall survival rate of 60% was observed in this trial,which far outperformed survival with chemotherapy alone(3).In the SECA-Ⅱ trial,enrollment was increased,and patients with better prognostic factors,including at least a 10% response to chemotherapy before the transplant,were selected.