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Prospective Assessment of Clinically Relevant Fluid Balance Thresholds Associated With Postoperative Complications in Advanced Ovarian Cancer

Hasselgren, Emma ; Groes-Kofoed, Nina ; Falconer, Henrik ; Bjorne, Hakan ; Zach, Diana ; Daniel, Hunde ; Johansson, Hemming ; Asp, Mihaela LU orcid ; Thorlacius, Karin LU and Kannisto, Päivi LU , et al. (2025) In Acta Anaesthesiologica Scandinavica 69(9).
Abstract
Background: Reliable data on optimal fluid management in the perioperative period for patients with advanced ovarian cancer undergoing cytoreductive surgery is limited. These patients often present with malignant ascites and are prone to significant fluid shifts perioperatively. For this reason, our objective was to define clinical targets for optimal fluid balance and determine whether initial ascites should be included in fluid-loss calculations by examining the association between perioperative fluid balance and major postoperative complications.

Methods: This prospective, observational study conducted in a centralized and public healthcare system setting in Sweden between 2020 and 2023 included patients with advanced ovarian... (More)
Background: Reliable data on optimal fluid management in the perioperative period for patients with advanced ovarian cancer undergoing cytoreductive surgery is limited. These patients often present with malignant ascites and are prone to significant fluid shifts perioperatively. For this reason, our objective was to define clinical targets for optimal fluid balance and determine whether initial ascites should be included in fluid-loss calculations by examining the association between perioperative fluid balance and major postoperative complications.

Methods: This prospective, observational study conducted in a centralized and public healthcare system setting in Sweden between 2020 and 2023 included patients with advanced ovarian cancer, > 18 years of age, scheduled for upfront cytoreductive surgery, an ASA physical status I-III with no speech/language issues. The primary outcome was major postoperative complication within 30 days of surgery. The measurements of fluid input and output, cut-offs for fluid balance, perioperative time, and postoperative complications were defined a priori. The association between fluid balance and major postoperative complications was assessed by multivariable regression, adjusted for predefined covariates, yielding odds ratios (OR) with 95% confidence intervals (CI).

Results: Of 175 enrolled patients, 162 were included in the final analysis. In the adjusted analysis, there was a significant association between fluid balance of 1750-2700 mL, OR 3.40 (95% CI 1.06-10.9; p = 0.04) and > 2700 mL, OR 3.91 (95% CI 1.33-11.5; p = 0.01) and major postoperative complications. When including initial ascites as fluid loss, a balance of > 2700 mL was associated with major postoperative complications, OR 2.59 (95% CI 1.01-6.66, p = 0.047).

Conclusion: An optimal target for perioperative fluid balance to decrease the odds of major postoperative complications is suggested to be < 1750 mL. If initial ascites is included as loss in the calculation of balance, the optimal target of fluid balance is suggested to be < 2700 mL. These results provide practical clinical reference values that may assist anesthesiologists and surgical teams in optimizing perioperative fluid management in advanced ovarian cancer.

Editorial comment: This secondary analysis of a trial ovarian cancer operative cohort assessed the relation of the estimated fluid balance over the operative day 24 h to major postoperative complications. The findings showed that the groups where the fluid balance was in the categories higher and also most positive had higher odds for having a major complication compared to the group with lowest fluid balance. Ascities fluid was an issue in this cohort, which was managed in the analysis. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Anaesthesiologica Scandinavica
volume
69
issue
9
article number
e70112
publisher
Blackwell Munksgaard
external identifiers
  • pmid:40856042
ISSN
0001-5172
DOI
10.1111/aas.70112
language
English
LU publication?
yes
id
cd89b751-2437-4069-a737-f052217c02b1
date added to LUP
2025-08-29 13:29:41
date last changed
2025-08-30 03:27:24
@article{cd89b751-2437-4069-a737-f052217c02b1,
  abstract     = {{Background: Reliable data on optimal fluid management in the perioperative period for patients with advanced ovarian cancer undergoing cytoreductive surgery is limited. These patients often present with malignant ascites and are prone to significant fluid shifts perioperatively. For this reason, our objective was to define clinical targets for optimal fluid balance and determine whether initial ascites should be included in fluid-loss calculations by examining the association between perioperative fluid balance and major postoperative complications.<br/><br/>Methods: This prospective, observational study conducted in a centralized and public healthcare system setting in Sweden between 2020 and 2023 included patients with advanced ovarian cancer, &gt; 18 years of age, scheduled for upfront cytoreductive surgery, an ASA physical status I-III with no speech/language issues. The primary outcome was major postoperative complication within 30 days of surgery. The measurements of fluid input and output, cut-offs for fluid balance, perioperative time, and postoperative complications were defined a priori. The association between fluid balance and major postoperative complications was assessed by multivariable regression, adjusted for predefined covariates, yielding odds ratios (OR) with 95% confidence intervals (CI).<br/><br/>Results: Of 175 enrolled patients, 162 were included in the final analysis. In the adjusted analysis, there was a significant association between fluid balance of 1750-2700 mL, OR 3.40 (95% CI 1.06-10.9; p = 0.04) and &gt; 2700 mL, OR 3.91 (95% CI 1.33-11.5; p = 0.01) and major postoperative complications. When including initial ascites as fluid loss, a balance of &gt; 2700 mL was associated with major postoperative complications, OR 2.59 (95% CI 1.01-6.66, p = 0.047).<br/><br/>Conclusion: An optimal target for perioperative fluid balance to decrease the odds of major postoperative complications is suggested to be &lt; 1750 mL. If initial ascites is included as loss in the calculation of balance, the optimal target of fluid balance is suggested to be &lt; 2700 mL. These results provide practical clinical reference values that may assist anesthesiologists and surgical teams in optimizing perioperative fluid management in advanced ovarian cancer.<br/><br/>Editorial comment: This secondary analysis of a trial ovarian cancer operative cohort assessed the relation of the estimated fluid balance over the operative day 24 h to major postoperative complications. The findings showed that the groups where the fluid balance was in the categories higher and also most positive had higher odds for having a major complication compared to the group with lowest fluid balance. Ascities fluid was an issue in this cohort, which was managed in the analysis.}},
  author       = {{Hasselgren, Emma and Groes-Kofoed, Nina and Falconer, Henrik and Bjorne, Hakan and Zach, Diana and Daniel, Hunde and Johansson, Hemming and Asp, Mihaela and Thorlacius, Karin and Kannisto, Päivi and Salehi, Sahar}},
  issn         = {{0001-5172}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{9}},
  publisher    = {{Blackwell Munksgaard}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Prospective Assessment of Clinically Relevant Fluid Balance Thresholds Associated With Postoperative Complications in Advanced Ovarian Cancer}},
  url          = {{http://dx.doi.org/10.1111/aas.70112}},
  doi          = {{10.1111/aas.70112}},
  volume       = {{69}},
  year         = {{2025}},
}