Perioperative fluid balance and major postoperative complications in surgery for advanced epithelial ovarian cancer

Gynecol Oncol. 2021 May;161(2):402-407. doi: 10.1016/j.ygyno.2021.02.034. Epub 2021 Mar 12.

Abstract

Objective: Appropriate fluid balance in the perioperative period is important as both hypo- and hypervolemia are associated with increased risk of complications. Women undergoing cytoreductive surgery (CRS) for advanced epithelial ovarian cancer (EOC) may have major fluid shifts. The optimal perioperative fluid balance in these women is yet to be determined. Our objective was to investigate the association between perioperative fluid balance and major postoperative complications.

Methods: Women with advanced stage EOC who underwent surgery at Karolinska University Hospital, Stockholm, Sweden were identified from the institutional database. Women subjected to surgery with curative intent were included in the analysis. Additional data were retrieved from medical records. The association between perioperative fluid balance and major postoperative complications was investigated by multivariable regression and adjusted for predefined confounders.

Results: Of the 270 women identified in the institutional database during 2014-2017, 184 women were included in the analyses. Of these women, 22% (n = 40) experienced a major postoperative complication. The fully adjusted odds of major postoperative complications increased when perioperative fluid balance exceeded >3000 mL, (Odds Ratio (OR) 4.85, 95% Confidence Interval (CI) 1.23-19.2, p = 0.02) and > 5000 mL (OR 33.7, 95% CI 4.13-275, p < 0.01). There was no association between negative fluid balance and major postoperative complications (OR 3.33, 95% CI 0.25-44.1, p = 0.36).

Conclusions: Fluid balance >3000 mL perioperatively during surgery for advanced EOC increased the odds of major postoperative complications. Management of perioperative fluid balance in advanced EOC surgery remains a challenge.

Keywords: Epithelial ovarian cancer; Fluid balance; Postoperative complications; Surgery.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Ovarian Epithelial / complications
  • Carcinoma, Ovarian Epithelial / physiopathology
  • Carcinoma, Ovarian Epithelial / surgery*
  • Cytoreduction Surgical Procedures*
  • Female
  • Humans
  • Logistic Models
  • Middle Aged
  • Odds Ratio
  • Ovarian Neoplasms / complications
  • Ovarian Neoplasms / physiopathology
  • Ovarian Neoplasms / surgery*
  • Perioperative Period
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Retrospective Studies
  • Risk Factors
  • Water-Electrolyte Balance*
  • Water-Electrolyte Imbalance / diagnosis
  • Water-Electrolyte Imbalance / etiology
  • Water-Electrolyte Imbalance / physiopathology*