Perioperative Interstitial Fluid Expansion Predicts Major Morbidity Following Pancreatic Surgery: Appraisal by Bioimpedance Vector Analysis

Marta Sandini, Salvatore Paiella, Marco Cereda, Marco Angrisani, Giovanni Capretti, Fabio Casciani, Simone Famularo, Alessandro Giani, Linda Roccamatisi, Elena Viviani, Riccardo Caccialanza, Marco Montorsi, Alessandro Zerbi, Claudio Bassi, Luca Gianotti

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To evaluate whether perioperative bioimpedance vector analysis (BIVA) predicts the occurrence of surgery-related morbidity. SUMMARY BACKGROUND DATA: BIVA is a reliable tool to assess hydration status and compartimentalized fluid distribution. METHODS: The BIVA of patients undergoing resection for pancreatic malignancies was prospectively measured on the day prior to surgery and on postoperative day (POD)1. Postoperative morbidity was scored per the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI). RESULTS: Out of 249 patients, the overall and major complication rates were 61% and 16.5% respectively. The median CCI was 24 (IQR 0.0-24.2), and 24 patients (9.6%) had a complication burden with CCI≥40. At baseline the impedance vectors of severe complicated patients were shorter compared to the vectors of uncomplicated patients only for the female subgroup (P=0.016). The preoperative extracellular water (ECW) was significantly higher in patients who experienced severe morbidity according to the CDC or not [19.4L (17.5-22.0) vs. 18.2L (15.6-20.6), P=0.009, respectively] and CCI≥40, or not [20.3L (18.5-22.7) vs. 18.3L (15.6-20.6), P=0.002, respectively]. The hydration index on POD1 was significantly higher in patients who experienced major complications than in uncomplicated patients (P=0.020 and P=0.025 for CDC and CCI, respectively).At a linear regression model, age (β=0.14, P=0.035), sex female (β=0.40, P<0.001), BMI (β=0.30, P<0.001), and malnutrition (β=0.14, P=0.037) were independent predictors of postoperative ECW. CONCLUSION: The amount of extracellular fluid accumulation predicts major morbidity after pancreatic surgery. Female, obese and malnourished patients were at high risk of extracellular fluid accumulation.

Original languageEnglish
Pages (from-to)923-929
Number of pages7
JournalAnnals of Surgery
Volume270
Issue number5
DOIs
Publication statusPublished - Nov 1 2019

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Perioperative Interstitial Fluid Expansion Predicts Major Morbidity Following Pancreatic Surgery: Appraisal by Bioimpedance Vector Analysis'. Together they form a unique fingerprint.

Cite this