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22.01.2019 | Review Article | Ausgabe 6/2019

Journal of Gastrointestinal Surgery 6/2019

Restrictive Versus Liberal Fluid Regimens in Patients Undergoing Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 6/2019
Autoren:
Mikaela L. Garland, Hamish S. Mace, Andrew D. MacCormick, Stuart A. McCluskey, Nicholas J. Lightfoot
Wichtige Hinweise
This study in its preliminary form was presented as an ePoster at the Australian and New Zealand College of Anaesthetists Annual Scientific Meeting, 12–16 May 2017, Brisbane, Australia.

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Abstract

Background

Pancreaticoduodenectomy is associated with significant morbidity and mortality which may be influenced by perioperative fluid management. It remains unclear whether liberal and restrictive fluid regimens impact mortality and morbidity in patients undergoing pancreaticoduodenectomy.

Methods

Medline, EMBASE, Cochrane Library and clinicaltrials.​gov were searched for studies comparing restrictive and liberal perioperative fluids in patients undergoing pancreaticoduodenectomy. Both prospective and retrospective studies in those undergoing pancreaticoduodenectomy were eligible for inclusion where the patient outcomes were stratified to restrictive and liberal perioperative fluid management regimens, with mortality as the primary outcome. Following study identification, a systematic review and meta-analysis with trial sequential analysis was completed.

Results

Thirteen studies including five prospective trials and eight retrospective analyses totalling 3062 patients were included. Restrictive fluid regimens were associated with a significant reduction in mortality compared to liberal fluid regimens for the overall cohort (odds ratio 0.54; 95% CI 0.31–0.94, p = 0.03). There were no significant differences in complication profile. Subgroup analysis revealed this result was contributed to significantly by retrospective studies. The results of the trial sequential analysis suggest this mortality benefit may be due to a type I statistical error and that further patient numbers are required for definitive conclusions.

Conclusions

Restrictive fluid regimens are associated with a reduction in mortality following pancreaticoduodenectomy. The clinical relevance of this finding needs to be interpreted pragmatically given the lack of association with significant causes of morbidity and in considering the results of the recently published RELIEF study.

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