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Abstract：
BACKGROUND: The association between perioperative fluid administration and risk of complications following emergency surgery is poorly studied. We tested the association between the perioperative fluid balance and postoperative complications following emergency surgery for gastrointestinal obstruction or perforation.
METHODS: We performed a re-assessment of data from the Goal-directed Fluid Therapy in Urgent Gastrointestinal Surgery Trial (GAS-ART) studying intra-operative stroke volume optimization and postoperative zero-balance fluid therapy versus standard fluid therapy. The cohort was divided into three groups at a perioperative fluid balance (FB) of low < 0 L, moderate 0-2 L, or high > 2 L. We used a propensity adjusted logistic regression to analyse the association with cardiopulmonary (primary outcome), renal, infectious, and wound healing complications. Further, the risk of complications was explored on a continuous scale of the FB.
RESULTS: We included 303 patients: 44 patients belonged to the low-FB group, 108 to the moderate-FB group, and 151 to the high-FB group. The median [interquartile range] perioperative FB was -0.9 L [-1.4, -0.6], 0.9 L [0.5, 1.3], and 3.8 L [2.7, 5.3]. The risk of cardiopulmonary complications was significantly higher in the High-FB group 3.4 (1.5-7.6), p = 0.002 (odds ratio (95% confidence interval). On a continuous scale of the fluid balance, the risk of cardiopulmonary complications was minimal at -1 L to 1 L.
CONCLUSIONS: Following emergency surgery for gastrointestinal obstruction or perforation, a fluid balance < 2.0 L was associated with decreased risk of cardiopulmonary complications without increasing renal complications.
METHODS: We performed a re-assessment of data from the Goal-directed Fluid Therapy in Urgent Gastrointestinal Surgery Trial (GAS-ART) studying intra-operative stroke volume optimization and postoperative zero-balance fluid therapy versus standard fluid therapy. The cohort was divided into three groups at a perioperative fluid balance (FB) of low < 0 L, moderate 0-2 L, or high > 2 L. We used a propensity adjusted logistic regression to analyse the association with cardiopulmonary (primary outcome), renal, infectious, and wound healing complications. Further, the risk of complications was explored on a continuous scale of the FB.
RESULTS: We included 303 patients: 44 patients belonged to the low-FB group, 108 to the moderate-FB group, and 151 to the high-FB group. The median [interquartile range] perioperative FB was -0.9 L [-1.4, -0.6], 0.9 L [0.5, 1.3], and 3.8 L [2.7, 5.3]. The risk of cardiopulmonary complications was significantly higher in the High-FB group 3.4 (1.5-7.6), p = 0.002 (odds ratio (95% confidence interval). On a continuous scale of the fluid balance, the risk of cardiopulmonary complications was minimal at -1 L to 1 L.
CONCLUSIONS: Following emergency surgery for gastrointestinal obstruction or perforation, a fluid balance < 2.0 L was associated with decreased risk of cardiopulmonary complications without increasing renal complications.
摘要：
背景：围手术期液体给药与急诊手术后并发症风险之间的关系研究甚少。我们测试了胃肠道梗阻或穿孔急诊手术后围手术期液体平衡与术后并发症之间的关系。
方法：我们对目标导向液体疗法在紧急胃肠手术试验（GAS-ART）中的数据进行了重新评估，研究了术中每搏输出量优化和术后零平衡液体疗法与标准液体疗法的比较。在低<0L的围手术期液体平衡（FB）下，将该队列分为三组，中等0-2升，或高>2L。我们使用倾向调整逻辑回归分析与心肺(主要结果)的关系，肾,传染性,伤口愈合并发症。Further,在FB的连续量表上探讨了并发症的风险.
结果：我们纳入了303例患者：44例患者属于低FB组，中度FB组108人，和151到高FB组。围手术期的中位数[四分位距]FB为-0.9L[-1.4,-0.6],0.9L[0.5,1.3],和3.8L[2.7,5.3]。高FB组3.4（1.5-7.6）发生心肺并发症的风险明显更高，p=0.002(比值比(95%置信区间)。在流体平衡的连续尺度上，在-1L至1L时，心肺并发症的风险很小。
结论：在胃肠道梗阻或穿孔的急诊手术后，体液平衡<2.0L与心肺并发症的风险降低相关,但不增加肾脏并发症.
方法：我们对目标导向液体疗法在紧急胃肠手术试验（GAS-ART）中的数据进行了重新评估，研究了术中每搏输出量优化和术后零平衡液体疗法与标准液体疗法的比较。在低<0L的围手术期液体平衡（FB）下，将该队列分为三组，中等0-2升，或高>2L。我们使用倾向调整逻辑回归分析与心肺(主要结果)的关系，肾,传染性,伤口愈合并发症。Further,在FB的连续量表上探讨了并发症的风险.
结果：我们纳入了303例患者：44例患者属于低FB组，中度FB组108人，和151到高FB组。围手术期的中位数[四分位距]FB为-0.9L[-1.4,-0.6],0.9L[0.5,1.3],和3.8L[2.7,5.3]。高FB组3.4（1.5-7.6）发生心肺并发症的风险明显更高，p=0.002(比值比(95%置信区间)。在流体平衡的连续尺度上，在-1L至1L时，心肺并发症的风险很小。
结论：在胃肠道梗阻或穿孔的急诊手术后，体液平衡<2.0L与心肺并发症的风险降低相关,但不增加肾脏并发症.
