Analysis On The Association of Intraoperative Fluid Balance and Short-Term Outcomes After Radical Gastrectomy in Aged Patients

Background: To observe the relationship between fluid balance and the short-term outcomes of aged patients after gastrectomy for gastric cancer in Nanjing Drum Tower Hospital.Methods: The clinical data of patients with gastrectomy for gastric cancer from January 2016 to December 2018 in Nanjing Drum Tower Hospital were retrospectively analyzed. According to the criteria of inclusion and exclusion, 691 patients who met the study conditions were analyzed according to intraoperative fluid balance recorded on patients who has undergone radical gastrectomy. Patients were classified into three fluid administration groups representing incremental quartiles of the primary exposure variable. Preoperative characteristics used for statistical adjustment included gender, age, weight, admission type, ASA degree. Operative factors included procedure duration, estimated blood loss, urine output, and so on. The primary outcomes included acute kidney injury (AKI).and postoperative respiratory complications (PRCs) Exploratory outcomes included length of stay, postoperative length of stay and total cost of hospitalization. The association between perioperative factors and AKI/PRCs in hospital was tested with multivariable logistic regression analyses.Results: 16 cases were diagnosed as AKI and 23 cases were diagnosed as PRCs. The association between intraoperative fluid balance and the incidence of acute kidney injury (AKI)/postoperative respiratory complications (PRCs) remained U-shaped but the difference was not statistically significant (P>0.05). After adjustment for potential confounders, lower urine output (P=0.017, OR=0.997,95%CI=0.994-0.999) and coronary heart disease (P=0.032, OR=4.867,95%CI=1.142-20.75) were independent predictor of AKI in aged patients after radical gastrectomy. Besides, coronary heart disease(OR=3.371,95%CI=1.021-11.129,P=0.049) and intestinal obstruction (OR=12.501,95%CI=3.058-51.107,P ＜0.0005) were independent predictor of PRCs in aged patients after radical gastrectomy.Conclusion: There were no significant association between the incidence of AKI or any other complications and intraoperative fluid balance during radical gastrectomy in aged patients. Lower urine output and coronary heart disease were independent predictors of AKI in aged patients after radical gastrectomy. Coronary heart disease and intestinal obstruction were independent predictors of PRCs in aged patients after radical gastrectomy.Trial registration: This study was approved by the Affiliated Drum Tower Hospital of Nanjing University (Registration number: 2018-162-01).