Introduction:Intravenous fluid management is integral to perioperative care, particularly under enhanced recovery after surgery (ERAS) protocols. In radical cystectomy (RC), which carries high risks of complications and mortality, optimizing fluid management poses a significant challenge due to the absence of definitive guidelines.Aim:the purpose of this study was to investigate the effects of intravenous fluid administration on postoperative complications in patients undergoing RC.Material and methods:This study involved 288 patients who underwent laparoscopic RC and urinary diversion from 2018 to 2022. ERAS protocols were implemented for all patients. Participants were divided into four groups based on the type of urinary diversion (ureterocutaneostomy vs. ileal conduit) and the intraoperative fluid volume input (less than 1000 mL vs. more than 1000 mL). Postoperative complications were evaluated at 30 and 90 days post-surgery using the Clavien-Dindo scale. The fluid management effectiveness was measured using the absolute Vascular Bed Filling Index (aVBFI) and the adjusted Vascular Bed Filling Index (adjVFBI).Results:The UCS is associated with a lower risk of increased severity of postoperative complications. The administration of more than 1000 mL of fluids was associated with a higher risk of complications (p= 0.035). However, after adjusting for the duration of the surgery and BMI, this association did not hold statistical significance, indicating that fluid volume alone is not a direct predictor of postoperative complications. At aVBFI values between zero and eight, urinary diversion using the UCS method is associated with a lower risk of complications compared to the IC. When aVBFI equals eight, the differences in the severity of complications between the UCS and the IC are minimal. However, when aVBFI exceeds eight, the IC is associated with fewer complications during the 30 days post-operation compared to the UCS. The correlation between the adjVFBI (B = −0.27; 95% CI: −0.45 to −0.08;p= 0.005) and the severity of complications up to 30 days postoperatively is similar to that seen with the aVBFI. Similarly, the correlation of the adjVFBI with the method of urinary diversion (B = 0.24; 95% CI: 0.06 to 0.43;p= 0.011) resembles that of the aVBFI. The volume of fluids administered and the indices aVBFI and adjVFBI did not influence the occurrence of complications 90 days postoperatively.Conclusions:The volume of fluids administered is not a factor directly affecting the occurrence of complications following RC when the ERAS protocol is used. The amount of intraoperative fluid administration should be adjusted according to the intraoperative blood loss. Our findings endorse the utility of aVBFI and adjVFBI as valuable tools in guiding fluid therapy within the framework of ERAS protocols. However, further multicenter randomized trials are needed to definitively determine the best fluid therapy regimen for patients undergoing RC.
引言：静脉输液管理是围手术期护理的重要组成部分，尤其在加速康复外科（ERAS）方案中。根治性膀胱切除术（RC）具有较高的并发症和死亡风险，由于缺乏明确的指南，优化液体管理成为一项重大挑战。 目的：本研究旨在探讨静脉输液对接受RC患者术后并发症的影响。 材料与方法：本研究纳入了2018年至2022年间接受腹腔镜RC及尿流改道术的288例患者。所有患者均实施ERAS方案。根据尿流改道方式（输尿管皮肤造口术与回肠膀胱术）和术中输液量（少于1000 mL与多于1000 mL），将参与者分为四组。术后并发症在术后30天和90天使用Clavien-Dindo分级进行评估。液体管理的有效性通过绝对血管床充盈指数（aVBFI）和调整后血管床充盈指数（adjVFBI）进行衡量。 结果：输尿管皮肤造口术与术后并发症严重程度增加的风险较低相关。输液量超过1000 mL与较高的并发症风险相关（p=0.035）。然而，在调整手术时间和体重指数后，这种关联不再具有统计学意义，表明液体量本身并非术后并发症的直接预测因素。当aVBFI值在0到8之间时，与回肠膀胱术相比，采用输尿管皮肤造口术进行尿流改道与较低的并发症风险相关。当aVBFI等于8时，输尿管皮肤造口术与回肠膀胱术在并发症严重程度上的差异最小。然而，当aVBFI超过8时，与输尿管皮肤造口术相比，回肠膀胱术在术后30天内并发症较少。adjVFBI（B = -0.27；95% CI：-0.45至-0.08；p=0.005）与术后30天内并发症严重程度的相关性与aVBFI观察到的相似。同样，adjVFBI与尿流改道方式的相关性（B = 0.24；95% CI：0.06至0.43；p=0.011）也与aVBFI相似。输液量以及aVBFI和adjVFBI指数并未影响术后90天并发症的发生。 结论：在使用ERAS方案时，输液量并非直接影响RC术后并发症发生的因素。术中输液量应根据术中失血量进行调整。我们的研究结果支持aVBFI和adjVFBI作为在ERAS方案框架内指导液体治疗的有价值工具。然而，需要进一步的多中心随机试验来明确确定接受RC患者的最佳液体治疗方案。
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