Riza M Cetik, Jeffrey L Gum, Renaud Lafage, Justin S Smith, Shay Bess, Jeffrey P Mullin, Michael P Kelly, Bassel G Diebo, Thomas J Buell, Justin K Scheer, Breton G Line, Virginie Lafage, Eric O Klineberg, Han Jo Kim, Peter G Passias, Khaled M Kebaish, Robert K Eastlack, Alan H Daniels, Alex Soroceanu, Gregory M Mundis, Richard A Hostin, Themistocles S Protopsaltis, D Kojo Hamilton, Robert A Hart, Munish C Gupta, Stephen J Lewis, Frank J Schwab, Lawrence G Lenke, Christopher I Shaffrey, Christopher P Ames, Douglas C Burton
{"title":"成人脊柱畸形手术的术中液体管理：变异分析及与预后的关系。","authors":"Riza M Cetik, Jeffrey L Gum, Renaud Lafage, Justin S Smith, Shay Bess, Jeffrey P Mullin, Michael P Kelly, Bassel G Diebo, Thomas J Buell, Justin K Scheer, Breton G Line, Virginie Lafage, Eric O Klineberg, Han Jo Kim, Peter G Passias, Khaled M Kebaish, Robert K Eastlack, Alan H Daniels, Alex Soroceanu, Gregory M Mundis, Richard A Hostin, Themistocles S Protopsaltis, D Kojo Hamilton, Robert A Hart, Munish C Gupta, Stephen J Lewis, Frank J Schwab, Lawrence G Lenke, Christopher I Shaffrey, Christopher P Ames, Douglas C Burton","doi":"10.1007/s43390-024-00966-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).</p><p><strong>Methods: </strong>Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input-output difference (IOD), and normalized input-output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes.</p><p><strong>Results: </strong>Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = -0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004).</p><p><strong>Conclusion: </strong>Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes.\",\"authors\":\"Riza M Cetik, Jeffrey L Gum, Renaud Lafage, Justin S Smith, Shay Bess, Jeffrey P Mullin, Michael P Kelly, Bassel G Diebo, Thomas J Buell, Justin K Scheer, Breton G Line, Virginie Lafage, Eric O Klineberg, Han Jo Kim, Peter G Passias, Khaled M Kebaish, Robert K Eastlack, Alan H Daniels, Alex Soroceanu, Gregory M Mundis, Richard A Hostin, Themistocles S Protopsaltis, D Kojo Hamilton, Robert A Hart, Munish C Gupta, Stephen J Lewis, Frank J Schwab, Lawrence G Lenke, Christopher I Shaffrey, Christopher P Ames, Douglas C Burton\",\"doi\":\"10.1007/s43390-024-00966-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).</p><p><strong>Methods: </strong>Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input-output difference (IOD), and normalized input-output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes.</p><p><strong>Results: </strong>Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = -0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004).</p><p><strong>Conclusion: </strong>Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes.</p><p><strong>Level of evidence: </strong>III.</p>\",\"PeriodicalId\":21796,\"journal\":{\"name\":\"Spine deformity\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine deformity\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s43390-024-00966-0\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine deformity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43390-024-00966-0","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes.
Purpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).
Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input-output difference (IOD), and normalized input-output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes.
Results: Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = -0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004).
Conclusion: Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes.
期刊介绍：
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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