Key result
Perioperative IV fluid >8000 mL linked to ~220% higher anastomotic leakage risk after rectal surgery.
Why the study?
Modifiable risk factors for anastomotic leakage after rectal cancer surgery were not well identified to improve clinical practice.
Does perioperative intravenous fluid >8000 ml increase the risk of anastomotic leakage in patients undergoing elective open anterior resection for rectal cancer?
Cohort (n=124)
Does perioperative intravenous fluid >8000 ml increase the risk of anastomotic leakage in patients undergoing elective open anterior resection for rectal cancer?
Odds Ratio: 3.2 (95% CI 1.1–9.31)
p-value: p=0.049
Administration of more than 8000 ml of perioperative intravenous fluid is associated with a significantly increased risk of anastomotic leakage after rectal cancer surgery.
Identifies candidate modifiable factors for anastomotic leakage; leaves open whether interventions reduce risk in rectal cancer surgery.
AIM: This study aimed to identify modifiable risk factors for anastomotic leakage during the postoperative period to recognize areas of clinical practice that could be improved. METHOD: Medical charts of patients who underwent elective open anterior resection for rectal cancer over a 5-year period were reviewed retrospectively. RESULTS: One hundred and twenty-four patients [64 men, mean age (± SD) 68.0 ± 9.0 years] underwent an anterior resection for rectal cancer during the study period. Twenty-two (17.7%) patients had anastomotic leakage. Patients who were given more than 8000 ml of intravenous fluid during the 72-h perioperative period had a statistically significant increased risk of developing anastomotic leakage [odds ratio (OR) 3.20, 95% confidence interval (CI) 1.10-9.31, P = 0.049] and the risk increased further when patients were given more than 8500 ml of intravenous fluid (OR 3.86, 95% CI 1.29-11.5, P = 0.019). The incidence of anastomotic leakage was not influenced by baseline comorbidity or tumour stage. CONCLUSION: Perioperative intravenous fluid of more than 8000 ml was associated with increased occurrence of anastomotic leakage. Vigorous monitoring of intravenous fluid use in the perioperative period may minimize this complication.
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Boesen et al. (2013) conducted a cohort in rectal cancer (n=124). Perioperative intravenous fluid > 8000 ml vs. Perioperative intravenous fluid ≤ 8000 ml was evaluated on anastomotic leakage (OR 3.20, 95% CI 1.10-9.31, p=0.049). Perioperative intravenous fluid administration exceeding 8000 ml was associated with a significantly increased risk of anastomotic leakage after rectal cancer surgery (OR 3.20; 95% CI 1.10-9.31; P=0.049).
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