(PM P31) Volume of Intraoperative Crystalloid Administration is Associated with Postoperative Respiratory Failure following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC)

Background Postoperative respiratory failure (PRF) is associated with increased morbidity after surgery. This retrospective study explores preoperative and intraoperative risk factors associated with PRF for patients undergoing CRS/ HIPEC. Methods We identified patients who underwent CRS/HIPEC at our institution between 2007 and 2017. PRF was defined as mechanical ventilation for greater than 48 hours after surgery or reintubation not related to an additional procedure. Clinicopathologic variables, PRF and overall survival (OS) were assessed using multiple regression and log-rank survival analysis. Results We identified 314 patients who underwent CRS/HIPEC. Twenty four of the 314 (7.6%) patients developed PRF. On univariable analysis, COPD was the only preoperative risk factor associated with PRF (p=0.049). Of the intraoperative risk factors, any diaphragmatic resection (p=0.008), increased peritoneal carcinomatosis index (PCI) (p<0.001), operative time (p<0.001), volume of intraoperative crystalloid (p<0.001), and estimated blood loss (p<0.001) were all associated with PRF. On multiple regression, only intraoperative crystalloid volume resuscitation was significantly associated with PRF (p<0.001). Five-year survival for patients with PRF was 30.2% compared to 52.6% for patients without PRF (HR of 2.6; 95% CI 1.5 – 4.4, p=0.001, see Figure 1). Conclusions Exaggerated crystalloid volume resuscitation is a potential independent intraoperative risk factor for PRF in CRS/HIPEC. To our knowledge, this is the first study to identify decreased OS in patients with PRF in the setting of CRS/HIPEC and highlights the importance of intraoperative goal directed resuscitation.