To observe the relationship between fluid balance and the short-term outcomes of aged patients after gastrectomy for gastric cancer in Nanjing Drum Tower Hospital.
The clinical data of patients with gastrectomy for gastric cancer from January 2016 to December 2018 were retrospectively analyzed. 691 patients were analyzed and classified into three fluid administration groups representing incremental quartiles of the primary exposure variable. Preoperative characteristics used for statistical adjustment included gender, age, weight, admission type, ASA degree. Operative factors included procedure duration, estimated blood loss, urine output, and so on. The primary outcomes included acute kidney injury (AKI), and postoperative respiratory complications (PRCs) Exploratory outcomes included length of stay, postoperative length of stay and total cost of hospitalization. The association between perioperative factors and AKI/PRCs in hospital was tested with multivariable logistic regression analyses.
16 cases were diagnosed as AKI and 23 cases PRCs. The association between intraoperative fluid balance and the incidence of AKI/ PRCs remained U-shaped but the difference was not statistically significant. After adjustment, lower urine output (P = 0.017, OR = 0.997,95%CI = 0.994–0.999) and coronary heart disease (P = 0.032, OR = 4.867,95%CI = 1.142–20.75) were independent predictor of AKI in aged patients. Coronary heart disease (OR = 3.371,95%CI = 1.021–11.129, P = 0.049) and intestinal obstruction (OR = 12.501,95%CI = 3.058–51.107, P < 0.0005) were independent predictor of PRCs in aged patients.
There were no significant association between the incidence of AKI or any other complications and intraoperative fluid balance during radical gastrectomy in aged patients. Lower urine output and coronary heart disease were independent predictors of AKI. Coronary heart disease and intestinal obstruction were independent predictors of PRCs in aged patients after radical gastrectomy.
This study was approved by the Affiliated Drum Tower Hospital of Nanjing University (Registration number: 2018-162-01).