Perioperative fluid status and surgical outcomes in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer

Diuresis is when the body has too many of certain substances in the fluid that the kidneys filter. Eventually this fluid becomes urine and increases the amount of water expelled by the body, leading to increased or excessive urination.
                                 ~~~~~~~~~~~~~~~~~~
abstract:

Highlights

•

Positive fluid status is common after cytoreductive surgery for advanced epithelial ovarian cancer.

•

Positive fluid status after cytoreductive surgery is associated with surgical site infections.

•

Fluid management is a key component of interventions to prevent surgical site infections.

---

Objective

The objective of this study is to investigate the impact of fluid status on perioperative outcomes of patients undergoing cytoreductive surgery (CRS) for advanced epithelial ovarian cancer (EOC).

Methods

Patients undergoing CRS for stage III or IV EOC at a comprehensive cancer center from 12/2010 to 05/2015 were identified. Those who underwent upper abdominal procedures or colon resections were included. Demographic, perioperative, and 30-day complication data were collected. Perioperative weight change was utilized as a surrogate for fluid status. The time to diuresis (tD) was defined as the postoperative day the patient's weight began to downtrend.

Results

One hundred ten patients were included. Median age was 62 years and median BMI 25.8 kg/m². The majority (74.5%) were stage IIIC. At least 1 bowel resection was performed in 60 cases (54.5%). A median of 5381 mL of crystalloid (range 1000–17,550 mL) and 500 mL of colloids (range 0–2783 mL) was given intraoperatively. The median perioperative weight change was + 7.3 kg (range − 0.9 kg to + 35.7 kg). The median tD was 3 days (range 1–17 days). On univariate analysis, net positive fluid status was associated with unscheduled reoperation, anastomotic leak, surgical site infections (SSI), and length of stay > 5 days. On multivariate analysis, fluid status was independently associated with SSI (p = 0.01). (surgical site infection)

Conclusions

Perioperative fluid excess is common in patients undergoing CRS for EOC and is independently associated with SSI.