Effect Of Intraoperative Fluid Therapy On Postoperative Outcome For Meningioma Resection Patients

Objective Restictive fluid therapy is generally considered to be beneficial for the postoperative recovery of intracranial tumor resection patients.Meningioma is the most common non-malignant brain tumor and the intraoperative fluid therapy during menongioma resection has its own particularity.However,there are few studies on intraoperative fluid therapy in patients with meningioma.We aim to evaluate the effect of intraoperative fluid therapy on the postoperative complications,postoperative length of stay(PLOS)and postoperative delayed extubation for meningioma resection patients based on the retrospectively collected real world data,so as to provide evidence for restrictive fluid therapy in this surgical population.Methods The data were collected from the Electronic Medical Record System and Electronic Surgery and Anesthesia System of Eastern Theater General Hospital(a large-scale tertiary class A comprehensive teaching hospital).Patients underwent elective meningioma resection and discharged from hospital from between January,1st and December 31st of 2019 were included.Basic demographic,tumor-related characteristics,intraoperative and postoperative data were collected.The primary exposure variable was the intraoperative fluid administration related factors.Total intraoperative fluid volume was defined as the total amount of fluid administrated from entering the operating room to transferred to the post-anesthesia care unit,which including the volume of crystalloids,colloids and allogenic blood products.Patients were classified based on the tertiles of total intraoperative fluid volume(low volume group,L group;medium volume group,M group and high volume group,H group).The observation outcomes were PLOS,postoperative complications and postoperative delayed extubation.Postoperative delayed extubation was defined as non-extubation in the post-anesthesia care unit.Univariate and multivariate analysis were used.Multivariate regression was performed to identify the association between the dependent variables(the observation outcomes)and all covariates with a P<0.1 on univariate analysis.Those with P<0.05 in the multivariate analysis was independent factors associated with the dependent variables.Receiver operator characteristics(ROC)analysis was used to evaluate the predictive effect of total intraoperative fluid volume for longer than the median PLOS.Result A total of 258 patients were included into analysis.The median intraoperative fluid volume was 1530ml.The median PLOS of H group(13 days)was longer than the L group(10 days)and M group(10 days).The total incidence of postoperative complications was higher in the H group than the L group(47.3%vs 24.2%,P=0.008).After adjusted for other factors,multivariate linear analysis showed intraoperative colloids volume(coefficient,0.006;95%CI 0.004-0.008,P<0.001)was associated with PLOS;and on multivariate logistic analysis,H group(OR 6.172,95%CI 2.398-15.890,P<0.001)and M group(OR 2.788,95%CI 1.310-5.931,P=0.008)had a higher risk of PLOS longer than 10days compared with L group.Multivariate logistic regression demonstrated that intraoperative transfusion(OR 4.597,95%CI 1.772-11.927,P=0.002)and postoperative delayed extubation(OR 3.738,95%CI 1.235-11.309,P=0.020)were independent risk factors of postoperative complications.The threshold for PLOS longer than 10 days was intraoperative fluids volume at 1505 mL(AUC 0.663),but the sensitivity and specificity were limited.No intraoperative fluid therapy related factor was found to be the independent predictor of postoperative delayed extubation.Conclusion Under the condition of our study,the increase of intraoperative fluid volume is a predictor of the prolonged PLOS,and the colloids volume is positively associated with PLOS.Whereas intraoperative transfusion and delayed extubation are risk factors of the occurrence of postoperative complications.