Journal of cardiothoracic and vascular anesthesia · 2026
The Impact of Intraoperative Fluid Management on Postoperative Complications Following Thoracic Surgery: An Evaluation From the German Thoracic Registry.
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Niedmers H, Wappler F, Defosse J, Weber J, Schieren M, working group of the German Thoracic Registry
Аннотация
OBJECTIVES: This study assessed the impact of perioperative crystalloid volume on postoperative complications after lung surgery. Postoperative pulmonary complications significantly affect morbidity and mortality, but the role of fluid management remains unclear.
DESIGN: Retrospective matched-pair analysis of the German Thoracic Registry (2016-2020), a national registry database.
SETTING: German Thoracic Registry data from multiple thoracic surgery centers across Germany (specialized, tertiary, and university hospitals).
PARTICIPANTS: A total of 6,917 patients undergoing thoracic surgery were included, and after patient selection (wedge resection, segmentectomy, lobectomy, bilobectomy, pneumonectomy) and application of exclusion criteria, a matching process was carried out. Two hundred four matched triplets (n = 612) were formed.
INTERVENTIONS: Differences were analyzed only in patients receiving crystalloid administration. Data on biometrics, perioperative management, and postoperative complications were analyzed, including subgroup analyses (wedge v anatomic resections). Regression and exploratory analyses identified potential volume thresholds with regard to the development of postoperative complications.
MEASUREMENTS AND MAIN RESULTS: A total crystalloid volume ≥2,500 mL was associated with higher overall and respiratory complication rates, especially the rate of pneumonia, in anatomic resections. Pleural drainage duration and hospital stay were prolonged, while nonpulmonary complications were unaffected. In wedge resections, infusion volume had minimal impact, except for longer pleural drainage and increased use of noninvasive ventilation.
CONCLUSIONS: Intraoperative crystalloid volume-largely independent of patient characteristics-is associated with increased postoperative complications. The effect is pronounced in anatomic resections and minimal in wedge resections. A total infusion volume ≥2,500 mL represents a critical threshold. These findings support evidence-based recommendations for perioperative fluid management to improve patient safety and highlight that a restrictive approach appears to be beneficial.
DESIGN: Retrospective matched-pair analysis of the German Thoracic Registry (2016-2020), a national registry database.
SETTING: German Thoracic Registry data from multiple thoracic surgery centers across Germany (specialized, tertiary, and university hospitals).
PARTICIPANTS: A total of 6,917 patients undergoing thoracic surgery were included, and after patient selection (wedge resection, segmentectomy, lobectomy, bilobectomy, pneumonectomy) and application of exclusion criteria, a matching process was carried out. Two hundred four matched triplets (n = 612) were formed.
INTERVENTIONS: Differences were analyzed only in patients receiving crystalloid administration. Data on biometrics, perioperative management, and postoperative complications were analyzed, including subgroup analyses (wedge v anatomic resections). Regression and exploratory analyses identified potential volume thresholds with regard to the development of postoperative complications.
MEASUREMENTS AND MAIN RESULTS: A total crystalloid volume ≥2,500 mL was associated with higher overall and respiratory complication rates, especially the rate of pneumonia, in anatomic resections. Pleural drainage duration and hospital stay were prolonged, while nonpulmonary complications were unaffected. In wedge resections, infusion volume had minimal impact, except for longer pleural drainage and increased use of noninvasive ventilation.
CONCLUSIONS: Intraoperative crystalloid volume-largely independent of patient characteristics-is associated with increased postoperative complications. The effect is pronounced in anatomic resections and minimal in wedge resections. A total infusion volume ≥2,500 mL represents a critical threshold. These findings support evidence-based recommendations for perioperative fluid management to improve patient safety and highlight that a restrictive approach appears to be beneficial.