Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

Objective: The purpose of this study was to explore the influence of positive fluid balance on cardiovascular complications after thoracotomy for noncancer lesions. Methods: After approval from an institutional review board, a retrospective cohort study was conducted. All consecutive patients underg...

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Main Authors: Tanyong Pipanmekaporn, Yodying Punjasawadwong, Somrat Charuluxananan, Worawut Lapisatepun, Pavena Bunburaphong, Somchareon Saeteng
Format: Journal
Published: 2018
Online Access:https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84903958761&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/45021
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Institution: Chiang Mai University
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spelling th-cmuir.6653943832-450212018-01-24T06:04:12Z Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions Tanyong Pipanmekaporn Yodying Punjasawadwong Somrat Charuluxananan Worawut Lapisatepun Pavena Bunburaphong Somchareon Saeteng Objective: The purpose of this study was to explore the influence of positive fluid balance on cardiovascular complications after thoracotomy for noncancer lesions. Methods: After approval from an institutional review board, a retrospective cohort study was conducted. All consecutive patients undergoing thoracotomy between January 1, 2005 and December 31, 2011 in a single medical center were recruited. The primary outcome of the study was the incidence of cardiovascular complications, which were defined as cardiac arrhythmia, cardiac arrest, heart failure, myocardial ischemia, and pulmonary embolism. Univariable and multivariable risk regression analyses were used to evaluate the association between positive fluid balance and cardiovascular complications. Results: A total of 720 patients were included in this study. The incidence of cardiovascular complications after thoracotomy for noncancer lesions was 6.7% (48 of 720). Patients with positive fluid balance > 2,000 mL had a significantly higher incidence of cardiovascular complications than those with positive fluid balance ≤2,000 mL (22.2% versus 7.0%, P=0.005). Cardiac arrhythmias were the most common complication. Univariable risk regression showed that positive fluid balance > 2,000 mL was a significant risk factor (risk ratio =3.15, 95% confident interval [CI] =1.44-6.90, P-value =0.004). After adjustment for all potential confounding variables during multivariable risk regression analysis, positive fluid balance > 2,000 mL remained a strong risk factor for cardiovascular complications (risk ratio =2.18, 95% CI =1.36-3.51, P-value =0.001). Causes of positive fluid balance > 2,000 mL included excessive hemorrhage (48%), hypotension without excessive hemorrhage (29.6%), and liberal fluid administration (22.4%). Conclusion: Positive fluid balance was a significant risk factor for cardiovascular complications. Strategies to minimize positive fluid balance during surgery for patients at high risk of cardiovascular complications include preparing adequate blood and blood products, considering appropriate hemoglobin level as a transfusion trigger, and adjusting the optimal dose of local anesthetic for intraoperative thoracic epidural analgesia. © 2014 Pipanmekaporn et al. 2018-01-24T06:04:12Z 2018-01-24T06:04:12Z 2014-07-03 Journal 11791594 2-s2.0-84903958761 10.2147/RMHP.S64585 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84903958761&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/45021
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
description Objective: The purpose of this study was to explore the influence of positive fluid balance on cardiovascular complications after thoracotomy for noncancer lesions. Methods: After approval from an institutional review board, a retrospective cohort study was conducted. All consecutive patients undergoing thoracotomy between January 1, 2005 and December 31, 2011 in a single medical center were recruited. The primary outcome of the study was the incidence of cardiovascular complications, which were defined as cardiac arrhythmia, cardiac arrest, heart failure, myocardial ischemia, and pulmonary embolism. Univariable and multivariable risk regression analyses were used to evaluate the association between positive fluid balance and cardiovascular complications. Results: A total of 720 patients were included in this study. The incidence of cardiovascular complications after thoracotomy for noncancer lesions was 6.7% (48 of 720). Patients with positive fluid balance > 2,000 mL had a significantly higher incidence of cardiovascular complications than those with positive fluid balance ≤2,000 mL (22.2% versus 7.0%, P=0.005). Cardiac arrhythmias were the most common complication. Univariable risk regression showed that positive fluid balance > 2,000 mL was a significant risk factor (risk ratio =3.15, 95% confident interval [CI] =1.44-6.90, P-value =0.004). After adjustment for all potential confounding variables during multivariable risk regression analysis, positive fluid balance > 2,000 mL remained a strong risk factor for cardiovascular complications (risk ratio =2.18, 95% CI =1.36-3.51, P-value =0.001). Causes of positive fluid balance > 2,000 mL included excessive hemorrhage (48%), hypotension without excessive hemorrhage (29.6%), and liberal fluid administration (22.4%). Conclusion: Positive fluid balance was a significant risk factor for cardiovascular complications. Strategies to minimize positive fluid balance during surgery for patients at high risk of cardiovascular complications include preparing adequate blood and blood products, considering appropriate hemoglobin level as a transfusion trigger, and adjusting the optimal dose of local anesthetic for intraoperative thoracic epidural analgesia. © 2014 Pipanmekaporn et al.
format Journal
author Tanyong Pipanmekaporn
Yodying Punjasawadwong
Somrat Charuluxananan
Worawut Lapisatepun
Pavena Bunburaphong
Somchareon Saeteng
spellingShingle Tanyong Pipanmekaporn
Yodying Punjasawadwong
Somrat Charuluxananan
Worawut Lapisatepun
Pavena Bunburaphong
Somchareon Saeteng
Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions
author_facet Tanyong Pipanmekaporn
Yodying Punjasawadwong
Somrat Charuluxananan
Worawut Lapisatepun
Pavena Bunburaphong
Somchareon Saeteng
author_sort Tanyong Pipanmekaporn
title Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions
title_short Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions
title_full Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions
title_fullStr Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions
title_full_unstemmed Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions
title_sort association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84903958761&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/45021
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