Vaughn E Nossaman, MS, William S Richardson, MD, James B Wooldridge, MD, Bobby D Nossaman, MD. Tulane University School of Medicine and Ochsner Medical Center.
Introduction: Studies are unclear regarding optimal intraoperative fluid management in laparoscopic bariatric surgery. The purpose of this study was to determine if the amount of intraoperative intravenous fluids affected hospital length of stay (hLOS).
Methods and Procedures: Data collected and analyzed with ChiSquare tests or logistic regression included reported patient demographics, comorbidities, intraoperative fluid administration, hLOS, and postoperative complications. Associated P values < 0.05 were taken to signify statistical significance. The data mining technique of partitioning was utilized to discover a cutting value of intraoperative fluid administration when plotted against hLOS.
Results: Preliminary logistic regression analysis of demographic and comorbidity variables revealed that in patients with a history of anemia (P = 0.01), obstructive sleep apnea (P = 0.01), and BMI (P = 0.01) were significantly related to increased hLOS (C statistic, 0.73). Lower rates of intraoperative IV fluid administration were significantly associated with increased hLOS (P = 0.001) (Fig. 1). Statistical analysis with the partition platform indicated a cutoff value of ≥ 1800 ml of intravenous fluid administration during anesthetic care resulted in lower hLOS when compared to bariatric patients receiving < 1800 ml (LogWorth 1.6). All patients staying greater than 2 days were within the < 1800 ml group (Fig. 2). Lower rates of intraoperative IV fluid administration significantly correlated with delayed wound healing (P = 0.008) (Fig. 3).
Figure 1 Figure 3
Conclusions: These data suggest the amount of intravenous fluids administered during laparoscopic surgery plays a significant role in hLOS, wound healing, and healthcare costs.