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A Dose-Response Analysis of Crystalloid Administration during Esophageal Resection.

Authors
  • Smith, Morgan1
  • Nossaman, Bobby1
  • 1 From the Department of Anesthesiology, Ochsner Clinic Foundation, and the Ochsner Clinical School program of the University of Queensland (Australia) School of Medicine, New Orleans, Louisiana. , (Australia)
Type
Published Article
Journal
Southern Medical Journal
Publisher
Southern Medical Association
Publication Date
Jul 01, 2019
Volume
112
Issue
7
Pages
412–418
Identifiers
DOI: 10.14423/SMJ.0000000000000991
PMID: 31282973
Source
Medline
Language
English
License
Unknown

Abstract

The purpose of this retrospective study was to investigate the role of intraoperative crystalloid administration on postoperative hospital length of stay (phLOS) and on the incidence of previously reported adverse events in 100 consecutive patients who underwent esophageal resection. The role of previously reported patient demographics, clinical characteristics, and intraoperative crystalloid administration on the duration of phLOS underwent statistical screening criteria for multivariable analysis, including the use of an instrumental variable to measure the role of unmeasured confounders on phLOS. Tests to assess the likelihood of causality also were performed. When the volumes of intraoperative crystalloids were expressed as dose-response relationships to outcomes, progressive decreases in phLOS, variances in phLOS, and the incidences of unplanned surgical intensive care unit admission, postoperative pneumonia, respiratory failure requiring orotracheal intubation, nonsinus cardiac dysrhythmias, and anastomotic leak were observed. Intraoperative transfusion of packed red blood cells greatly increased the duration of phLOS, which was not associated with estimated blood loss, length of surgical operation, or unplanned surgical intensive care unit admission. Instrumental variable analysis revealed no significant influence on phLOS. Causality tests supported the role of intraoperative crystalloid administration in reducing the duration and variance of phLOS. A dose-response relationship was clinically observed between intraoperative crystalloid administration and the duration and variance of phLOS and with commonly reported postoperative adverse events. Intraoperative transfusion of packed red blood cells greatly increased phLOS that was not associated with the severity of the surgical operation. Instrumental variables and tests for causality further supported the role of intraoperative crystalloid administration in reducing the duration and variance of phLOS.

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