Stastistical impact of the influence of a restrictive type of infusion therapy on the gastrointestinal motility recovery after pancreaticoduodenectomy

Introduction. Recently, a paradigm shift appears in concepts of perioperative infusion management towards limited infusion volume. The basis for this was research that showed that an excess in volumes of crystalloid solutions intercauses fluid deposition in the intestitinum, disrupting tissue perfusion and oxygenation, which subsequently induces postoperative complications, primarily delayed gastric emptying (DGE).Materials and methods. To evaluate the efficacy of the perioperative treatment regimens, a prospective retrospective study was conducted. The results of pancreaticoduodenectomy (PD) in 78 patients with benign and malignant lesions of the biliopancreatoduodenal zone from 2003 to 2017 were analyzed. From 2015, an enhanced recovery program (ERAS) was started in our clinic for patients undergoing PD. For the purpose of comparative analysis, the patients were divided into two groups: in I group 39 patients were included treated in accordance with the ERAS. In II group, 39 patients were retrospectively selected the treatment of which was carried out according to the traditional method. The volume of intraoperative infusion therapy, cardiac index, lactate, blood pressure, albumin level, time to recovery of gastrointestinal motility (GIM) and the frequency of DGE were studied. Results. Intraoperative infusion therapy by volume of applied solutions was significantly lower in I group (2100 ml 95% CI: [2100; 2300] vs 3300 ml 95% CI: [3100; 3500]; p <0.001). In patients of I group after the use of intraoperative infusion therapy of restrictive type, the medians index of cardiac index according to the Fik‘s formula was 3.6 l / min / m2, lactate – 1.2 mmol / l, systolic blood pressure – 126 mmHg, diastolic blood pressure / 75 mmHg and albumin level in the first postoperative day – 33 g / l. Patients in I group returned to normal diet faster than patients in the group II (1 day 95% CI: [1; 1] vs 6 days 95% CI: [6; 7] p < 0.001). The restriction of intraoperative infusion, removal of nasogastric tube (NGT) with the onset of oral nutrition from the first day significantly affected the significant decrease in the frequency of DGE in I group compared to II (14 (35.9%) versus 6 (15.4%) (by Cox test -Fishera p = 0.0098). In the statistical analysis, according to the ROC curve, the relationship between the volume of intraoperative infusion and the term for removal of the NGT and the recovery of oral nutrition in the postoperative period was revealed.Conclusions. The use of the restrictive type of infusion therapy in the concept of ERAS significantly reduces the реriod of recovery of the gastrointestinal motility, reducing the rate of DGE in patients after PD. The statistically significant factor influencing the possibility of early oral nutrition was the volume of intraoperative infusion in patients after PD.