Therapeutics and Clinical Risk Management (Dec 2019)
Intraoperative Urine Output Is Associated with Postoperative Outcome in Pediatric Population Undergone Major Abdominal Operations
Abstract
Chao Zheng,1,2 Chunbao Guo2,3 1Department of Orthopedics, Children’s Hospital, Chongqing Medical University, Chongqing 400014, People’s Republic of China; 2Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Pediatric General Surgery and Liver Transplantation, Children’s Hospital, Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Chunbao GuoDepartment of Pediatric General Surgery and Liver Transplantation, Children’s Hospital, Chongqing Medical University, 136 Zhongshan 2nd Rd, Chongqing 400014, People’s Republic of ChinaTel +86-23-63631839Fax +86-23-63622874Email [email protected]: Few data support the advantage of confirming a low urine output target during Roux-en-Y hepaticojejunostomy, which was widely used as an indication for fluid administration. We aimed at evaluating postoperative outcomes in terms of urine output in pediatric patients undergoing elective Roux-en-Y hepaticojejunostomy.Methods: We retrospectively reviewed 689 patients who had undergone Roux-en-Y hepaticojejunostomy between January 2007 and August 2014 at the Children’s Hospital of the Chongqing Medical University. Patients were dichotomized according to the average amount of corrected urine output (6.01 mL/kg*h) as a cut-off point. The primary endpoint was the occurrence of renal complications. The secondary endpoints included prompt postoperative gastrointestinal function recovery, postoperative complications and hospital length of stay.Results: The lower urine output had a proportional association with lesser amounts of crystalloid fluids (12.99±6.52 and 17.36±7.74 mL/kg*h for low and high urine output, respectively, p=0.006). For patients with a lower urine output, there were trends toward lower incidence rates of grade II postoperative complications (OR, 0.68; 95CI, 0.45–1.03; p=0.041) and accelerated recovery of gastrointestinal function, as indicated by the first flatus (p=0.015) and first bowel movement (p=0.008); however, the occurrence of renal complications did not show significant differences between the groups. The total length of hospital stay was shorter in patients with low urine output (7.59±1.24 days) than that in patients with a high urine output (8.01±2.31 days, p = 0.016).Conclusion: Lower urine output is associated with a lower incidence rate II postoperative complications and accelerated recovery of gastrointestinal function, without increasing the occurrence of renal complications in pediatric patient undergone hepaticojejunostomy. The optimal amount of urine output and associated fluid administration should be further investigated.Keywords: intraoperative urine output, Roux-en-Y hepaticojejunostomy, postoperative recovery, acute kidney injury
