Association between cumulative fluid balance to estimated colloid oncotic pressure ratio and postoperative outcome in surgical patients requiring intensive management.

Abstract

The integrity of the capillary endothelium and the filtration pressure regulate extravascular fluid leakage. A low plasma colloid oncotic pressure can contribute to extravascular leakage, which, when associated with a positive fluid balance, might lead to postoperative complications. Cumulative fluid balance and estimated colloid oncotic pressure were noted until postoperative 72 hours in 200 adult patients undergoing major emergency requiring intensive care management. All participants were followed until hospital discharge (or death) for any postoperative complications as per Clavien-Dindo grade. The primary outcome was the association between cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours and postoperative complications any time during the hospital stay. One hundred forty-seven of the 197 patients (74.6%) developed at least 1 postoperative complication. The incidence of major postoperative complications, defined as Clavien-Dindo grade IV and V, was 28.4%. Within the follow-up period, 29 patients (14.7%) died. No independent association between the cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours and the occurrence of any postoperative complications (P = .093) was found. However, ordinal logistic regression reported that a higher cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours was independently associated with a higher grade of complications (P = .009). The cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours (P = .012) was also independently associated with major postoperative complications. However, no independent association was found between cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours and in-hospital mortality (P = .160) or hospital-free days at day 30 (P = .985). The cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours was associated with increased postoperative complications, irrespective of the patient's baseline clinical status. Excessive fluid therapy should be discouraged in these patients, especially when serum proteins are low.