Journal Article

Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes

Kelly, Michael P., Kebaish, Khaled M., Lenke, Lawrence G., Shaffrey, Christopher I., Hart, Robert A., Diebo, Bassel G., Hamilton, D. Kojo, Lafage, Renaud, Smith, Justin S., Burton, Douglas C., Passias, Peter G., Gum, Jeffrey L., Klineberg, Eric O., Line, Breton G., Lewis, Stephen J., Mundis, Gregory M., Hostin, Richard A., Lafage, Virginie, Bess, Shay, Soroceanu, Alex, Daniels, Alan H., Schwab, Frank J., Mullin, Jeffrey P., Protopsaltis, Themistocles S., Cetik, Riza M., Scheer, Justin K., Eastlack, Robert K., Ames, Christopher P., Kim, Han Jo, Buell, Thomas J., Gupta, Munish C.

2025

Overview

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.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Aged / Back surgery / Blood products / Body mass index / Case Series / Cohort Studies / Colloids - administration & dosage / Crystalloid Solutions / Female / Fluid Therapy - methods / Fluid Therapy - statistics & numerical data / Fluids / Frailty / Hemodynamics / Hospitals / Humans / Intensive care / Intensive Care Units - statistics & numerical data / Intraoperative Care - methods / Length of stay / Length of Stay - statistics & numerical data / Male / Medicine / Medicine & Public Health / Middle Aged / Orthopedics / Patients / Population / Postoperative Complications / Recovery (Medical) / Retrospective Studies / Spinal Curvatures - surgery / Treatment Outcome / Trends / Urine / Variables