Intraoperative fluids and postoperative renal function in major gyneco-oncologic surgery: a retrospective study

Background: Acute kidney injury (AKI) is a common postoperative complication in major surgeries, including gynecologic cancer surgeries, but the relationship between intraoperative fluid management and postoperative AKI remains unclear. This study aims to evaluate the effect of perioperative fluid management strategies on postoperative renal function in patients undergoing major gynecologic cancer surgeries. Methods: This retrospective study analyzed data from 164 patients aged 18 years and older who underwent gynecologic cancer surgery. Patients were classified into three groups based on fluid management strategy: noninvasive goal-directed fluid therapy (NI-GDFT), minimally invasive goal-directed fluid therapy (MI-GDFT), and conventional fluid therapy (CFT). The primary objective was to evaluate the effect of fluid management on the development of postoperative AKI, as defined by the Acute Kidney Injury Network (AKIN) criteria. Secondary objective was to assess the intraoperative fluid volumes and postoperative non-renal complications. Results: When fluid management strategies were evaluated, it was observed that the amount of intraoperative fluid used in goal-directed fluid therapy regimens was lower than that used in conventional fluid regimens (p < 0.05). There were more postoperative complications in the CFT group compared to the NI-GDFT and MI-GDFT groups, including a higher incidence of AKI on postoperative day 1 (p < 0.05). The duration of hospitalization and the length of intensive care unit (ICU) stays were similar across all groups. Conclusions: Our retrospective data suggest that goal-directed fluid management, supported by advanced hemodynamic monitoring, might help reduce the incidence of postoperative AKI in patients undergoing major gynecologic cancer surgery. Clinical Trial Registration: NCT06101498.

Advanced hemodynamic monitoring; Acute kidney injury; Conventional fluid therapy; Goal-directed fluid therapy; Intraoperative fluid management

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