Crystalloids vs. colloids during minimally invasive oesophagectomy and their influence on postoperative acute kidney injury, mortality, and morbidity: a retrospective observational study
Crystalloids, colloids, oesophagectomy, acute kindey injury (AKI)
Published online: May 17 2024
Abstract
Background: Open oesophagectomy is associated with significant morbidity and mortality. Minimally Invasive Oesophagectomy (MIE) is proven to be an effective less invasive alternative. Appropriate intravenous (I.V.) fluid therapy during this procedure remains a challenge. It remains unclear if colloids such as hydroxyethyl starch (HES) or gelatines are safe and efficacious for intraoperative use.
Objectives: In this study we examined if adding colloids to crystalloids intraoperatively had an effect on postoperative Acute Kidney Injury (AKI), mortality, and morbidity; when compared to using only crystalloids.
Design and setting: This retrospective observational study included 220 patients who underwent a MIE at the University Hospital of Ghent.
Methods: The usage of only crystalloids was compared with the usage of crystalloids and colloids (HES and/or gelatines). The primary outcome was AKI as defined by KDIGO criteria. Secondary outcomes were mortality (at 30 days, 90 days, and 1 year), length of stay (LOS) in the hospital, and the incidence of postoperative pneumonia.
Results: 184 patients were administered only crystalloids, against 32 patients who were administered crystalloids and colloids (HES and/or gelatines). AKI occurred in only 2 patients (one in each fluid group), no further analyses was possible for this outcome. The estimated difference in 30-day, 90-day, and 1-year survival probability is 0.003 (95% CI: -0.003, 0.008), 0.012 (95% CI: -0.013, 0.037), and 0.04 (95% CI: -0.048, 0.129), respectively. There is thus a small, but non-significant, benefit of adding HES or gelatines during the operation. No significant effect was found for LOS or postoperative pneumonia.
Conclusion: The administration of intraoperative colloids (HES or gelatines) alongside with crystalloids during MIE, was not associated with an increase in the incidence of AKI, mortality, length of stay, or postoperative pneumonia, when compared with only crystalloids.
