Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis
Background. The perioperative management of pancreaticoduodenectomy is complicated, and the significant morbidity and mortality may be influenced by the method of intraoperative fluid management. Whether intraoperative restrictive fluid therapy can affect the outcomes of pancreaticoduodenectomy or n...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2020/5658685 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849398274196242432 |
|---|---|
| author | Jian Wang Wenchong Sun Zhongbao Fan Xin An Ling Pei |
| author_facet | Jian Wang Wenchong Sun Zhongbao Fan Xin An Ling Pei |
| author_sort | Jian Wang |
| collection | DOAJ |
| description | Background. The perioperative management of pancreaticoduodenectomy is complicated, and the significant morbidity and mortality may be influenced by the method of intraoperative fluid management. Whether intraoperative restrictive fluid therapy can affect the outcomes of pancreaticoduodenectomy or not is controversial. Methods. PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov were searched for prospective and retrospective studies comparing restrictive and liberal intraoperative fluids in patients undergoing pancreaticoduodenectomy. Following study identification, a systematic review and meta-analysis were performed. Results. Fourteen studies, including six prospective trials and eight retrospective studies, involving 2,596 patients, were included. Intraoperative restrictive fluid regimens had no effect on the mortality compared to liberal fluid regimens in the overall cohort (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 0.82–2.35, p=0.773). Liberal fluid regimens could increase the risk of pulmonary adverse events (OR: 1.66; 95% CI: 1.10–2.50, p=0.131) and prolong the length of hospital stay (SMD -0.10; 95% CI -0.19– -0.01, p=0.375). There were no significant differences in the incidence of pancreatic fistulas. Conclusions. Restrictive fluid regimens have a slight effect on the outcomes of pancreaticoduodenectomy. The clinical relevance of this finding needs to be interpreted. The existing evidence may not be adequate; therefore, further studies are warranted. |
| format | Article |
| id | doaj-art-9d4b43b9ad284e03be4fd84f651ed830 |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-9d4b43b9ad284e03be4fd84f651ed8302025-08-20T03:38:39ZengWileyGastroenterology Research and Practice1687-61211687-630X2020-01-01202010.1155/2020/56586855658685Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-AnalysisJian Wang0Wenchong Sun1Zhongbao Fan2Xin An3Ling Pei4The 2nd Department of Anesthesiology, First Hospital of China Medical University, Shenyang, Liaoning, ChinaThe 2nd Department of Anesthesiology, First Hospital of China Medical University, Shenyang, Liaoning, ChinaDepartment of Hepatobiliary Surgery, Liaoning People’s Hospital, Shenyang, Liaoning, ChinaDepartment of Intensive Care Unit, First Hospital of China Medical University, Shenyang, Liaoning, ChinaThe 2nd Department of Anesthesiology, First Hospital of China Medical University, Shenyang, Liaoning, ChinaBackground. The perioperative management of pancreaticoduodenectomy is complicated, and the significant morbidity and mortality may be influenced by the method of intraoperative fluid management. Whether intraoperative restrictive fluid therapy can affect the outcomes of pancreaticoduodenectomy or not is controversial. Methods. PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov were searched for prospective and retrospective studies comparing restrictive and liberal intraoperative fluids in patients undergoing pancreaticoduodenectomy. Following study identification, a systematic review and meta-analysis were performed. Results. Fourteen studies, including six prospective trials and eight retrospective studies, involving 2,596 patients, were included. Intraoperative restrictive fluid regimens had no effect on the mortality compared to liberal fluid regimens in the overall cohort (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 0.82–2.35, p=0.773). Liberal fluid regimens could increase the risk of pulmonary adverse events (OR: 1.66; 95% CI: 1.10–2.50, p=0.131) and prolong the length of hospital stay (SMD -0.10; 95% CI -0.19– -0.01, p=0.375). There were no significant differences in the incidence of pancreatic fistulas. Conclusions. Restrictive fluid regimens have a slight effect on the outcomes of pancreaticoduodenectomy. The clinical relevance of this finding needs to be interpreted. The existing evidence may not be adequate; therefore, further studies are warranted.http://dx.doi.org/10.1155/2020/5658685 |
| spellingShingle | Jian Wang Wenchong Sun Zhongbao Fan Xin An Ling Pei Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis Gastroenterology Research and Practice |
| title | Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis |
| title_full | Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis |
| title_fullStr | Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis |
| title_short | Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis |
| title_sort | effect of the type of intraoperative restrictive fluid management on the outcome of pancreaticoduodenectomy a systematic review and meta analysis |
| url | http://dx.doi.org/10.1155/2020/5658685 |
| work_keys_str_mv | AT jianwang effectofthetypeofintraoperativerestrictivefluidmanagementontheoutcomeofpancreaticoduodenectomyasystematicreviewandmetaanalysis AT wenchongsun effectofthetypeofintraoperativerestrictivefluidmanagementontheoutcomeofpancreaticoduodenectomyasystematicreviewandmetaanalysis AT zhongbaofan effectofthetypeofintraoperativerestrictivefluidmanagementontheoutcomeofpancreaticoduodenectomyasystematicreviewandmetaanalysis AT xinan effectofthetypeofintraoperativerestrictivefluidmanagementontheoutcomeofpancreaticoduodenectomyasystematicreviewandmetaanalysis AT lingpei effectofthetypeofintraoperativerestrictivefluidmanagementontheoutcomeofpancreaticoduodenectomyasystematicreviewandmetaanalysis |