Following Lung Resection: Does the volume of perioperative fluid affect patient outcomes?

Abstract

Introduction: Appropriate amount of intraoperative intravenous (IV) fluid has been controversial in thoracic surgery. In our study, we investigated outcome measures associated with patients undergoing lung resection for non-small cell lung cancer (NSCLC) and the correlation with perioperative IV fluids. Methods: A retrospective review of consecutive patients undergoing open lobectomy and bilobectomy for primary NSCLC between January 2010 and June 2016 was performed. Patient were divided into those receiving intraoperative IV fluid less than 7 cc/ kg/hr, 7 to 10 cc/kg/hr, and equal to or greater than 10 cc/kg/hr. Postoperative IV fluid was also recorded. We compared this against patient’s demographics, intraoperative parameters and complication rate. Results: 142 patients with the mean age of 66.5 years were identified. There was no significant difference in the hospital or ICU stay between any of the groups. Patients who received greater than 10 cc/kg/hr intraoperative IV fluids have higher rate of one or more complications and reoperation rate. Patients who had greater than 1.5 cc/kg/hr perioperative fluid have significantly higher duration of chest tube in-situ and pulmonary complication rate. Patients receiving less than 7 cc/kg/hr intraoperative IV fluids have no benefits compare to the group receiving larger IV fluid. Conclusions: In our study, giving high amounts of intraoperative and perioperative IV fluid has adverse effects on postoperative complications. Giving less (< 7 cc/kg/hr) intraoperative IV fluid has no additional benefits. We propose the optimal amount of intraoperative and perioperative IV fluid given should be in between these two extremes.