Restrictive Versus Liberal Fluid Regimens in Patients Undergoing Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis.
Background: Pancreaticoduodenectomy is associated with significant morbidity and mortality which may be influenced by perioperative fluid management. It remains unclear whether liberal and restrictive fluid regimens impact mortality and morbidity in patients undergoing pancreaticoduodenectomy.Method...
| Publicado en: | Journal of Gastrointestinal Surgery Vol. 23; no. 6; pp. 1250 - 1266 |
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| Autores principales: | , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
Jun2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=136444947&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 136444947 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1091255X KIT jtl: Journal of Gastrointestinal Surgery issn: 1091255X maglogo: N pubinfo: dt: Jun2019 vid: 23 iid: 6 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 136444947 136444947 NLM30671798 136444947 10.1007/s11605-018-04089-6 NLM30671798 136444947 ppf: 1250 ppct: 16 formats: tig: atl: Restrictive Versus Liberal Fluid Regimens in Patients Undergoing Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis. aug: au: Garland, Mikaela L. Mace, Hamish S. MacCormick, Andrew D. McCluskey, Stuart A. Lightfoot, Nicholas J. affil: Department of Anaesthesia and Pain Medicine, Middlemore Hospital, 100 Hospital Road, Otahuhu, 2025, Auckland, New Zealand sug: subj: Fluid Therapy Methods Pancreaticoduodenectomy Adverse Effects Pancreaticoduodenectomy Mortality Prospective Studies Retrospective Design Statistics Postoperative Complications Etiology Validation Studies Comparative Studies Evaluation Research Multicenter Studies Systematic Review Meta Analysis Human ab: Background: Pancreaticoduodenectomy is associated with significant morbidity and mortality which may be influenced by perioperative fluid management. It remains unclear whether liberal and restrictive fluid regimens impact mortality and morbidity in patients undergoing pancreaticoduodenectomy.Methods: Medline, EMBASE, Cochrane Library and clinicaltrials.gov were searched for studies comparing restrictive and liberal perioperative fluids in patients undergoing pancreaticoduodenectomy. Both prospective and retrospective studies in those undergoing pancreaticoduodenectomy were eligible for inclusion where the patient outcomes were stratified to restrictive and liberal perioperative fluid management regimens, with mortality as the primary outcome. Following study identification, a systematic review and meta-analysis with trial sequential analysis was completed.Results: Thirteen studies including five prospective trials and eight retrospective analyses totalling 3062 patients were included. Restrictive fluid regimens were associated with a significant reduction in mortality compared to liberal fluid regimens for the overall cohort (odds ratio 0.54; 95% CI 0.31-0.94, p = 0.03). There were no significant differences in complication profile. Subgroup analysis revealed this result was contributed to significantly by retrospective studies. The results of the trial sequential analysis suggest this mortality benefit may be due to a type I statistical error and that further patient numbers are required for definitive conclusions.Conclusions: Restrictive fluid regimens are associated with a reduction in mortality following pancreaticoduodenectomy. The clinical relevance of this finding needs to be interpreted pragmatically given the lack of association with significant causes of morbidity and in considering the results of the recently published RELIEF study. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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