Abstract: Objective To evaluate the association between early postoperative fluid balance(FB) and postoperative pancreatic fistula(POPF) in patients undergoing pancreaticoduodenectomy(PD).Methods A retrospective analysis of 237 consecutive patients admitted in the surgical intensive care unit(SICU) after PD was performed and the preoperative, intraoperative and postoperative clinical data were collected. The patients were divided into POPF group and Non-POPF group. Univariate Logistic regression analysis was applied to screen risk factors for POPF. A multivariate Logistic regression model was developed and included potential confounding factors. The patients were divided into 4 groups according to cumulative fluid balance postoperatively at 48 h(FB 48 h) as follows:group 1(FB 48 h ≤ 0 mL·kg^-1·h^-1), group 2(0 mL·kg^-1·h^-1 < FB 48 h ≤ 0.5 mL·kg^-1·h^-1), group 3(0.5 mL·kg^-1·h^-1 < FB 48 h ≤ 1 mL·kg^-1·h^-1) and group 4(FB 48 h>1 mL·kg^-1·h^-1). The association between FB 48 h and POPF was analyzed by Chi-square test.Results POPF occurred in 30 patients(12.6%) with grade B POPF occurred in 24 patients(10.1%), and grade C POPF occurred in 6 patients(2.5%). In multivariate Logistic regression model, sex(male)(OR=23.917, 95% CI:3.775-151.526, P=0.001), body mass index(BMI) (OR=1.313,95% CI:1.059-1.628, P=0.013), diabetes(OR=9.120, 95% CI:2.262-36.771, P=0.002), low albumin levels on admission(OR=0.876, 95% CI:0.783-0.981, P=0.022), preoperative high bilirubin level(OR=1.008, 95% CI:1.002-1.013, P=0.005) and FB 48 h(OR=4.870, 95% CI:1.906-12.443, P=0.001) were risk factors for POPF. The incidence of grade C POPF was significantly increased when FB 48 h was more than 1 mL·kg^-1·h^-1 (P=0.001).Conclusion In patients undergoing PD, FB 48 h was the independent risk factor for POPF. The incidence of grade C POPF was significantly increased when FB 48 h more than 1 mL·kg^-1·h^-1.

Key words: pancreaticoduodenectomy (PD), postoperative pancreatic fistula (POPF), fluid balance