Retrospective Research Of Postoperative Fluid Management And Electrolyte Disorders After Hepatectomy Under The Concept Of Enhanced Recovery After Surgery

BackgroundEnhanced Recovery after Surgery(ERAS),know as using a series of optimal treatment measures proven by evidence-based medical evidence to reduce the traumatic stress response of patients during perioperative period,so as to promote the recovery of physiological homeostasis of patients after surgery.Thus,the comfort level of patients can be improved,the length of hospital stay can be shortened,complications can be reduced,re-hospitalization rate and death risk can be reduced,and medical costs can be reduced in the same time.It has been widely used in perioperative management of various operations.Hepatectomy is the main surgical method for the treatment of benign and malignant liver diseases.Compared with other abdominal operations,hepatectomy is complicated,with high technical requirements,few standard operations,great changes in surgical procedures and other clinical characteristics,with higher incidence of postoperative complications,reoperation rate and mortality.Therefore,ERAS pathway for liver resection is more complex than other abdominal procedures,and individualized management plans should be formulated for the specific situation of patients to maximize perioperative safety and achieve truly enhanced recovery.Water and electrolyte disorder is a common complication after abdominal surgery and an important factor affecting postoperative recovery and prognosis of patients.The ERAS philosophy encourages early postoperative feeding and restricted intravenous fluids to promote functional recovery of the gastrointestinal tract and prevent complications associated with excessive fluid management.However,the correlation between ERAS and electrolyte disorder after hepatectomy and its prevention and management strategies are stayed unknown.In this study,propensity score matching was used to retrospectively compare the water and electrolyte disorder after hepatectomy under two management modes.PurposeTo investigate the relevance between enhanced recovery after surgery(ERAS)and postoperative fluid management and electrolyte disorders after hepatectomy,of which prevention and management strategies is discussed as well.MethodA Retrospective case-control study was conducted to analyze data from 152 patients with ERAS management and 233 patients with conventional management after hepatectomy.The difference of fluid and main electrolyte supplementation,serum electrolyte concentration and electrolyte disorder were analyzed after propensity score matching(PSM).Logistic regression was used to comprehensively analyze the risk factors of postoperative hypokalemia.ROC curve was conducted to analyze the predictors of postoperative hypokalemia.ResultsAfter PSM,107 ERAS and 135 conventionally managed cases were included.The amount of intravenous fluid and potassium supplementation on the 1st,2nd and 4th postoperative days(POD1,POD2,POD4)in ERAS group was significantly lower than that in the traditional group.The proportion of patients with potassium supplementation on POD4 after ERAS surgery was significantly lower than that in the traditional group(17.76%vs.94.81%,P<0.05).The postoperative serum potassium level in ERAS group was significantly lower than that in the traditional group,and the incidence of hypokalemia on POD5 in ERAS group was significantly higher than that in the traditional group(33.64%vs.22.22%,P<0.05).Regression analysis showed that ERAS was a risk factor for hypokalemia after hepatectomy(OR 3.234,95%CI 2.021-5.176,P<0.05).Age and serum potassium level on POD1 were independent risk factors for hypokalemia(OR 1.033,95%CI1.008-1.058,P<0.05;OR 3.073,95%CI 1.335-7.072,P<0.05),and serum potassium level on POD3 and intravenous potassium supplementation on POD4 were independent protective factors(0.009,95%CI 0.003-0.032,P<0.05;0.582,95%CI0.468-0.723,P<0.05).ROC curve analysis showed that serum potassium ≤3.86mmol/L on POD3 was the best cut-off value for predicting the occurrence of hypokalemia on POD5.ConclusionIntravenous fluid restriction after hapatectomy under the concept of enhanced recovery after surgery is safe to implement.Hypokalemia is more likely to occur because of the reduce of intravenous potassium supplementation and deficiency of oral intake.Postoperative fluid replacement should avoid excessive use of physiological saline,which would result in hyperchloremia.