World Journal of Surgery

, Volume 43, Issue 3, pp 929–936 | Cite as

Intraoperative Fluid Administration and Surgical Outcomes Following Pancreaticoduodenectomy: External Validation at a Tertiary Referral Center

  • M. Sandini
  • C. Fernández-del Castillo
  • C. R. Ferrone
  • K. J. Ruscic
  • M. Eikermann
  • A. L. Warshaw
  • K. D. Lillemoe
  • M. QadanEmail author
Original Scientific Report (including Papers Presented at Surgical Conferences)



While intraoperative fluid overload is associated with higher complication rates following surgery, data for pancreaticoduodenectomy are scarce and heterogeneous. We evaluated multiple prior definitions of restrictive and liberal fluid regimens and analyzed whether these affected surgical outcomes at our tertiary referral center.


Studies evaluating different intraoperative fluid regimens on outcomes after pancreatic resections were retrieved. After application of all prior definitions of restrictive and liberal fluid regimens to our patient cohort, relative risks of each outcome were calculated using all reported infusion regimens.


Five hundred and seven pancreaticoduodenectomies were included. Nine different fluid regimens were evaluated. Two regimens utilized absolute volume cutoffs, and the remaining evaluated various infusion rates, ranging from 5 to 15 mL/kg/h. Total volume administration of >5000 mL and >6000 mL was associated with increased complications (RR 1.25 and RR 1.17, respectively) and >6000 mL with increased sepsis (RR 2.14). Conversely, a rate of <5 mL/kg/h was associated with increased risk of postoperative pancreatic fistula (POPF, RR 3.16) and sepsis (RR 3.20), <6.8 mL/kg/h with increased major morbidity (RR 1.64) and sepsis (RR 2.27), and <8.2 mL/kg/h with increased POPF (RR 2.16). No effects were observed on pulmonary complications, surgical site infections, length of stay, or mortality.


In an uncontrolled setting with no standard intraoperative or postoperative care map, the volume of intraoperative fluid administration appears to have limited impact on early postoperative outcomes following pancreaticoduodenectomy, with adverse outcomes only seen at extreme values.


Compliance with ethical standards

Conflict of interest

The authors have no conflict of interests to disclose.

Supplementary material

268_2018_4842_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 26 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • M. Sandini
    • 1
  • C. Fernández-del Castillo
    • 1
  • C. R. Ferrone
    • 1
  • K. J. Ruscic
    • 2
  • M. Eikermann
    • 2
  • A. L. Warshaw
    • 1
  • K. D. Lillemoe
    • 1
  • M. Qadan
    • 1
    Email author
  1. 1.Department of Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

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