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Dextrose-Containing Carrier Solution for Hyperthermic Intraperitoneal Chemotherapy: Increased Intraoperative Hyperglycemia and Postoperative Complications

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Intraoperative hyperglycemia is associated with infectious complications in general surgery patients. This study aimed to determine if the use of lactated Ringer’s (LR) carrier solution during hyperthermic intraperitoneal chemotherapy (HIPEC) would lower the incidence of intraoperative hyperglycemia and improve postoperative outcomes when compared with a standard 1.5% dextrose peritoneal dialysate carrier solution.

Patients and Methods

This is a retrospective cohort study of 134 patients who underwent HIPEC at the University of Colorado. Perioperative glucose levels and outcomes were compared between patients who were perfused with 1.5% dextrose peritoneal dialysate carrier solution (n = 68) versus LR carrier solution (n = 66).

Results

The study population consisted of patients undergoing HIPEC for appendiceal (50%), colorectal (34%), mesothelioma (8%), and ovarian cancer (5%). Intraoperative severe hyperglycemia (glucose ≥ 180 mg/dL) was significantly more common among patients perfused with a dextrose-containing carrier solution versus those perfused with LR (88% vs. 21%; p < 0.001). Patients in the dextrose cohort had significantly more severe complications (39% vs. 12%; p = 0.034), infectious complications (35% vs. 15%; p = 0.011), and organ space infections (18% vs. 5%: p = 0.026) than the LR cohort. On multivariable analysis, dextrose-containing carrier solution was significantly associated with an increased risk of postoperative infectious complications (HR 5.16; p = 0.006).

Conclusions

Intraoperative hyperglycemia is common when dextrose-containing carrier solution is used during HIPEC, and severe intraoperative hyperglycemia is strongly associated with an increased risk for infectious of complications following HIPEC. LR carrier solution should be routinely used to reduce intraoperative hyperglycemia and its associated risks.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Robert J. Torphy MD, Piyush Sharma MD, Alison L. Halpern MD, Kristen Oase PA-C, Whitney Herter PA-C, Christan Bartsch MPH, PA-C, Chloe Friedman MPH, Marco Del Chiaro MD, PhD, Richard D. Schulick MD, MBA, Ana Gleisner MD, PhD, Martin D. McCarter MD & Steven A. Ahrendt MD

  2. Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA

    Camille Stewart MD

Authors
  1. Robert J. Torphy MD
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  2. Camille Stewart MD
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  3. Piyush Sharma MD
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  4. Alison L. Halpern MD
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  5. Kristen Oase PA-C
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  6. Whitney Herter PA-C
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  7. Christan Bartsch MPH, PA-C
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  8. Chloe Friedman MPH
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  9. Marco Del Chiaro MD, PhD
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  10. Richard D. Schulick MD, MBA
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  11. Ana Gleisner MD, PhD
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  12. Martin D. McCarter MD
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  13. Steven A. Ahrendt MD
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Correspondence to Steven A. Ahrendt MD.

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Torphy, R.J., Stewart, C., Sharma, P. et al. Dextrose-Containing Carrier Solution for Hyperthermic Intraperitoneal Chemotherapy: Increased Intraoperative Hyperglycemia and Postoperative Complications. Ann Surg Oncol 27, 4874–4882 (2020). https://doi.org/10.1245/s10434-020-08330-y

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  • DOI: https://doi.org/10.1245/s10434-020-08330-y

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