Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/140153
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Type: | Journal article |
Title: | Fluid management and vasopressor use during colorectal surgery: the search for the optimal balance |
Author: | Huisman, D.E. Bootsma, B.T. Ingwersen, E.W. Reudink, M. Slooter, G.D. Stens, J. Daams, F. Roumen, R.M.H.M.H. van Rooijen, S.J. Bleeker, W. Stassen, L.P.S. Jongen, A. Feo, C.V. Targa, S. Komen, N. Kroon, H.M. Sammour, T. Lagae, E.A.G.L. Talsma, A.K. Wegdam, J.A. et al. |
Citation: | Surgical Endoscopy: surgical and interventional techniques, 2023; 37(8):6062-6070 |
Publisher: | Springer Science and Business Media LLC |
Issue Date: | 2023 |
ISSN: | 0930-2794 1432-2218 |
Statement of Responsibility: | Daitlin E. Huisman, Boukje T. Bootsma, Erik W. Ingwersen, Muriël Reudink, Gerrit D. Slooter, Jurre Stens, Freek Daams, on behalf of the LekCheck Study group |
Abstract: | Background Although it is known that excessive intraoperative fuid 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 signifcantly difered between the patients receiving vasopressor agents during surgery compared to patients without (11.8% vs 6.3%, p<0.001). CAL was signifcantly 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. |
Keywords: | Colorectal anastomotic leakage; Vasopressors; Fluid management |
Rights: | © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
DOI: | 10.1007/s00464-023-09980-1 |
Published version: | http://dx.doi.org/10.1007/s00464-023-09980-1 |
Appears in Collections: | Medicine publications |
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