Intraoperative fluid management in patients undergoing CRS-HIPEC, a retrospective study

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Introduction CRS-HIPEC requires complex perioperative fluid management due to the associated physiologic disturbances. Several studies have postulated that restrictive intraoperative fluid management is associated with decreased postoperative morbidity. Evidence-based guidelines for fluid management in CRS-HIPEC have not yet been established and proper management of intraoperative fluid therapy remains controversial. Methods We performed a retrospective cohort study on patients undergoing CRS-HIPEC at a high-volume center with a total of 620 procedures performed from March 2011 to December 2020. Patients were split into restrictive and liberal fluid administration groups by intraoperative fluid administration rate and the primary outcome of comprehensive complication index (CCI) was compared between groups. Univariable and multivariable regression analyses were performed to evaluate the association of perioperative factors on outcomes and to control for confounding factors. Results Of 620 total procedures performed, 58 were excluded due to missing data. In the remaining procedures, patients had a mean age of 55 years (range 20, 86), mean peritoneal carcinomatosis index of 13.8 (CI 13.1, 14.5), and mean intraoperative fluid administration rate of 12.1mL/kg/hr (CI 11.7, 12.5). The mean CCI for the restrictive fluid management group was 12.5 (CI 10.8, 14.3) and for the liberal group was 14.2 (CI 12.5, 16.1) [p = 0.18]. Univariable and multivariable regression analyses showed no association between intraoperative fluid rate and CCI (univariable coefficient=0.17, p=0.19; multivariable coefficient=0.14, p=0.52). Conclusions Restrictive intraoperative fluid management during CRS-HIPEC is not associated with decreased postoperative morbidity as measured by CCI. Synopsis This is the largest study to date evaluating the association of intraoperative fluid administration with postoperative complications in patients undergoing CRS-HIPEC. We find that fluid administration strategy is not associated with postoperative complications. Rather than restrictive management, our study suggests that fluid administration should be tailored to individual patient needs.

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