• Ryan S D'Souza, Charles R Sims, Nicole Andrijasevic, Thomas M Stewart, Timothy B Curry, James A Hannon, Shanda Blackmon, Stephen D Cassivi, Robert K Shen, Janani Reisenauer, Dennis Wigle, and Michael J Brown.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
• J. Cardiothorac. Vasc. Anesth. 2021 Oct 1; 35 (10): 2952-2960.

ObjectivesEsophagectomy is associated with significant morbidity and mortality. The authors assessed the relationship between intraoperative fluid (IOF) administration and postoperative pulmonary outcomes in patients undergoing a transthoracic, transhiatal, or tri-incisional esophagectomy.DesignRetrospective cohort study (level 3 evidence).SettingTertiary care referral center.ParticipantsPatients who underwent esophagectomy from 2007 to 2017.InterventionsThe IOF rate (mL/kg/h) was the predictor variable analyzed both as a continuous and binary categorical variable based on median IOF rate for this cohort (11.90 mL/kg/h).MeasurementsPrimary outcomes included rates of acute respiratory distress syndrome (ARDS) within ten days after esophagectomy. Secondary outcomes included rates of reintubation, pneumonia, cardiac or renal morbidity, intensive care unit admission, length of stay, procedure-related complications, and mortality. Multivariate regression analysis determined associations between IOF rate and postoperative outcomes. Analysis was adjusted for age, sex, body mass index, procedure type, year, and thoracic epidural use.Main ResultsA total of 1,040 patients comprised this cohort. Tri-incisional esophagectomy was associated with a higher hospital mortality rate (7.8%) compared with transthoracic esophagectomy (2.6%, p = 0.03) or transhiatal esophagectomy (0.7%, p = 0.01). Regression analysis revealed a higher IOF rate was associated with greater ARDS within ten days (adjusted odds ratio [OR] = 1.03, p = 0.01). For secondary outcomes, a higher IOF rate was associated with greater hospital mortality (adjusted OR = 1.05, p = 0.002), although no significant association with 30-day hospital mortality was identified.ConclusionsIncreased IOF administration during esophagectomy may be associated with worse postoperative pulmonary complications, specifically ARDS. Future well-powered studies are warranted, including randomized, controlled trials comparing liberal versus restrictive fluid administration in this surgical population.Copyright © 2021 Elsevier Inc. All rights reserved.

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