Intraoperative Fluid Rate and Postoperative Complications for Pancreatoduodenectomy.

Background: With the advent of ERAS protocols, there has been a trend towards restricted fluid management for pancreatic surgery. We hypothesized that restricted fluid administration would be associated with reduced postoperative complications and shorter hospital length of stay for patients treated with pancreatoduodenectomy.

Methods: Retrospective study design evaluating patients treated with a pancreatoduodenectomy at a large, single institution from 2004-2024. Patients were stratified by total intra-operative fluid administration (colloid and crystalloid): <500mL/hr (low fluid group) or ≥500mL/hr (high fluid group). 1:1 nearest neighbor propensity score matching was performed, matching on receipt of neoadjuvant chemotherapy, pathologic diagnosis, estimated blood loss, and technical aspects (minimally invasive and/or pylorus preservation).

Results: Of 933 patients undergoing pancreatoduodenectomy, 542 received <500mL/hr of intraoperative fluids (low fluids) and 391 received ≥500mL/hr (high fluids). High fluid administration was associated with more complex procedures, including increased vascular resections (8.7% vs. 5.2%; P=0.045) and higher estimated blood loss (200 [75, 475] mL vs. 75 [25, 165] mL; P<0.001). Among cancer patients, the high fluid group more often had positive margins (14.0% vs. 9.6%; P=0.03). After propensity score matching, overall complication rates were not significantly different, but the high fluid group experienced slower return of bowel function (liquids: 3 [1,4] vs. 2 [1,3]; P<0.001; solids: 5 [3,6] vs. 4 [2,5]; P=0.002).

Conclusions: High fluid administration (≥500mL/h) during pancreatoduodenectomywas associated with delayed return of bowel function without an increase in complication risk. This finding might support the restricted delivery of fluids in pancreatoduodenectomy.