TY - JOUR
T1 - Intraoperative fluid management in adult spinal deformity surgery
T2 - variation analysis and association with outcomes
AU - International Spine Study Group
AU - Cetik, Riza M.
AU - Gum, Jeffrey L.
AU - Lafage, Renaud
AU - Smith, Justin S.
AU - Bess, Shay
AU - Mullin, Jeffrey P.
AU - Kelly, Michael P.
AU - Diebo, Bassel G.
AU - Buell, Thomas J.
AU - Scheer, Justin K.
AU - Line, Breton G.
AU - Lafage, Virginie
AU - Klineberg, Eric O.
AU - Kim, Han Jo
AU - Passias, Peter G.
AU - Kebaish, Khaled M.
AU - Eastlack, Robert K.
AU - Daniels, Alan H.
AU - Soroceanu, Alex
AU - Mundis, Gregory M.
AU - Hostin, Richard A.
AU - Protopsaltis, Themistocles S.
AU - Hamilton, D. Kojo
AU - Hart, Robert A.
AU - Gupta, Munish C.
AU - Lewis, Stephen J.
AU - Schwab, Frank J.
AU - Lenke, Lawrence G.
AU - Shaffrey, Christopher I.
AU - Ames, Christopher P.
AU - Burton, Douglas C.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Scoliosis Research Society 2024.
PY - 2025/1
Y1 - 2025/1
N2 - Purpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS). Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input–output difference (IOD), and normalized input–output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes. Results: Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = −0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004). Conclusion: Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes. Level of evidence: III.
AB - Purpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS). Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input–output difference (IOD), and normalized input–output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes. Results: Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = −0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004). Conclusion: Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes. Level of evidence: III.
KW - Adult spinal deformity
KW - Fluid management
KW - IV fluid
KW - Intraoperative fluid
UR - http://www.scopus.com/inward/record.url?scp=85203807347&partnerID=8YFLogxK
U2 - 10.1007/s43390-024-00966-0
DO - 10.1007/s43390-024-00966-0
M3 - Article
C2 - 39264408
AN - SCOPUS:85203807347
SN - 2212-134X
VL - 13
SP - 241
EP - 250
JO - Spine deformity
JF - Spine deformity
IS - 1
ER -