Evidence map›Paper›PMID 39264408›Full record

ArticleSpine deformity2025

Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes.

Riza M Cetik, Jeffrey L Gum, Renaud Lafage, Justin S Smith, Shay Bess, Jeffrey P Mullin, Michael P Kelly, Bassel G Diebo, Thomas J Buell, Justin K Scheer and 22 more

Abstract readMulticenter StudyComparative Study
PubMed Publisher
In one paragraph

Article in Spine deformity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Cervical scoliosis surgery: understanding neurological complications and defining prevention strategies. A biomechanical study and narrative review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Riza M CetikNorton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, USA. rizamert.cetik@louisville.edu.ORCID http://orcid.org/0000-0001-9390-4129
Jeffrey L GumNorton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, USA.
Renaud LafageNorthwell, Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA.
Justin S SmithDepartment of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
Shay BessDepartment of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA.
Jeffrey P MullinDepartment of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Michael P KellyDepartment of Orthopaedic Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA.
Bassel G DieboDepartment of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Thomas J BuellDepartment of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Justin K ScheerDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Breton G LineDepartment of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA.
Virginie LafageNorthwell, Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA.
Eric O KlinebergDepartment of Orthopaedic Surgery, University of California-Davis, Davis, CA, USA.
Han Jo KimDepartment of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Peter G PassiasDepartment of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
Khaled M KebaishDepartment of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Robert K EastlackDepartment of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA.
Alan H DanielsDepartment of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Alex SoroceanuDepartment of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada.
Gregory M MundisDepartment of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA.
Richard A HostinDepartment of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA.
Themistocles S ProtopsaltisDepartment of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
D Kojo HamiltonDepartment of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Robert A HartDepartment of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA.
Munish C GuptaDepartment of Orthopedic Surgery, Washington University, St Louis, MO, USA.
Stephen J LewisDepartment of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada.
Frank J SchwabNorthwell, Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA.
Lawrence G LenkeDepartment of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA.
Christopher I ShaffreyDepartment of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Christopher P AmesDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Douglas C BurtonDepartment of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
International Spine Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).

methodsMulticenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input-output difference (IOD), and normalized input-output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes.

resultsSeven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = -0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004).

conclusionSignificant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes. LEVEL OF EVIDENCE: III.

Indexed as

Fluid TherapyIntraoperative CareSpinal CurvaturesAdultAgedCohort StudiesColloidsCrystalloid SolutionsFemaleHumansIntensive Care UnitsLength of StayMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesColloidsCrystalloid SolutionsAdult spinal deformityFluid managementIntraoperative fluidIV fluid

Identifiers

PMID39264408

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.