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

Figures & data

Table 1 Patient characteristics and operative and anesthetic data

Parameters	Positive fluid balance >2,000 mL (n=27)	Positive fluid balance ≤2,000 mL (n=441)	P-value
Demographic data
Age (years), mean ± SD	49.5±13.9	51.5±16.2	0.538
≤55, n (%)	17 (63.0%)	251 (57.0%)
>55, n (%)	10 (37.0%)	190 (43.0%)
Sex, n (%)			0.419
Female	5 (18.5%)	112 (25.6%)
Male	22 (81.5%)	328 (74.4%)
Body mass index (kg/m^2), mean ± SD	19.4±3.4	20.5±3.7	0.275
ASA classification, n, %			0.783
1	2 (7.4%)	49 (11.1%)
2	15 (55.6%)	249 (56.5%)
3	10 (37.0%)	143 (32.4%)
Comorbidity
Hypertension, n, %			0.089
No	25 (92.6%)	348 (79.0%)
Yes	2 (7.4%)	92 (21.0%)
Diabetes mellitus, n, %			0.340
No	25 (92.6%)	380 (86.2%)
Yes	2 (7.4%)	61 (13.8%)
Renal disease, n, %			0.468
No	25 (92.6%)	387 (88.0%)
Yes	2 (7.4%)	53 (12.0%)
Coronary artery disease, n, %			0.566
No	26 (96.3%)	429 (98.0%)
Yes	1 (3.7%)	9 (2.0%)
Preoperative hemoglobin (g/dL), mean ± SD	11.1±2.0	11.5±2.0	0.346
Operative details
Surgical conditions, n, %			0.640
Elective surgery	12 (44.4%)	217 (49.2%)
Emergency surgery	15 (55.6%)	223 (50.8%)
Type of lesions, n, %			0.807
Non-infection	6 (22.2%)	107 (24.3%)
Infection	21 (77.8%)	324 (75.7%)
Type of operations, n, %			<0.001
Parenchymal resection	11 (40.7%)	110 (25.0%)
Nonparenchymal resection	16 (59.3%)	331 (75.0%)
Duration of surgery (min), mean ± SD	216.7±80.5	131.0±61.7	<0.001
≤180, n, %	9 (34.6%)	362 (82.0%)
>180, n, %	17 (65.4%)	79 (18.0%)
Intraoperative hypotension, n, %			<0.001
No	20 (74.0%)	419 (95.0%)
Yes	7 (16.0%)	22 (5.0%)

Abbreviations: ASA, American Society of Anesthesiologists classification; min, minutes; SD, standard deviation.

Table 2 Univariable risk regression of postoperative cardiovascular complications

Parameters	Risk ratio	95% CI	P-value
Demographic data
Age >55 versus ≤55 years	3.15	1.68–5.88	<0.001
Comorbidity
Hypertension	1.67	0.90–3.08	0.101
Diabetes mellitus	1.86	0.94–3.69	0.077
Renal diseases	1.79	0.87–3.67	0.112
Coronary artery disease	6.45	3.14–13.22	<0.001
Infection versus noninfection	1.13	0.55–2.31	0.733
Operative details
Type of operation
Parenchymal resection versus nonparenchymal resection	1.32	0.71–2.45	0.375
Duration of surgery >180 versus ≤180 minutes	2.62	1.44–4.75	0.002
Anesthetic details
Intraoperative hypotension	3.50	1.77–6.93	<0.001
Positive fluid balance >2,000 versus ≤2,000 mL	3.15	1.44–6.90	0.004

Abbreviation: CI, confidence interval.

Table 3 Multivariable risk regression of postoperative cardiovascular complications

Parameters	Risk ratio	95% CI	P-value
Demographic data
Age >55 versus ≤55 years	3.41	1.94–5.98	<0.001
Co‐morbidity
Hypertension	0.74	0.37–1.49	0.402
Diabetes mellitus	2.36	1.41–3.96	0.001
Renal diseases	1.13	0.56–2.30	0.727
Coronary artery disease	4.62	2.22–9.59	<0.001
Operative details
Duration of surgery >180 versus ≤180 minutes	2.42	1.21–4.85	0.012
Parenchymal versus non-parenchymal resection	1.19	0.60–2.37	0.615
Anesthetic details
Intraoperative hypotension	3.11	1.79–5.42	<0.001
Positive fluid balance >2,000 versus ≤2,000 mL	2.18	1.36–3.51	0.001

Abbreviation: CI, confidence interval.

Table 4 Amount of fluid intake and blood components classified by positive fluid balance

Fluid intake and output	Positive fluid balance >2,000 mL (n=27)	Positive fluid balance ≤2,000 mL (n=544)	P-value
Total fluid intake (mL), mdn (IQR)	4,280 (3,500–5,000)	1,150 (650–1,800)	<0.001
Crystalloid	3,000 (2,200–3,350)	900 (580–1,350)	<0.001
Colloids	1,000 (0–1,700)	0	<0.001
Packed red blood cell (mL)	530 (0–800)	0	<0.001
0 units, n (%)	10 (37.0%)	459 (84.3%)
1–3 units, n (%)	12 (44.4%)	81 (15.0%)
>3 units, n (%)	5 (18.6%)	4 (0.7%)
Fresh frozen plasma (mL) mdn (IQR)	0 (0–190)	0	<0.001
0 units	20 (74.0%)	523 (96.0%)
1–3 units	3 (11.0%)	14 (2.7%)
>3 units	4 (15.0%)	7 (1.3%)
Platelets (mL), mdn (IQR)	280 (200–360)	0	<0.001
0 units, n (%)	25 (92.6%)	544 (100.0%)	<0.001
1–3 units, n (%)	0	0
>3 units, n (%)	2 (7.4%)	0
Intraoperative blood loss (mL), mdn (IQR)	800 (400–1,500)	200 (100–300)	<0.001
<500, n (%)	10 (37.0%)	452 (83.0%)
500–1,000, n (%)	6 (22.3%)	76 (14.0%)
>1,000, n (%)	11 (40.7%)	16 (3.0%)
Urine output (mL), mdn (IQR)	420 (180–900)	200 (100–375)	0.001

Abbreviations: mdn, median; IQR, interquartile range.

Table 5 Causes of positive fluid balance

Causes	n (%)
Excessive hemorrhage	13 (48.0%)
Hypotension without evidence of significant hemorrhage	8 (29.6%)
Liberal fluid administration	6 (22.4%)