The safety assessment of irrigation fluid management for shoulder arthroscopy and its effect on postoperative efficacy

Abstract Background context: With the popularity of shoulder arthroscopy, the releted complications have recently studied, among which the excessive fluid extravasation is a potentially dangerous complication. Most relevant studies involve respiratory system, while the reports fouced on the cardiovascular system and postoperative function recovery are rare. The objective is to reveal the effects of the excessive fluid extravasation on cardiovascular system and postoperative functionMethod: A retrospective analysis was made on the clinical data of 92 patients, in whom 84 cases of rotator cuff injury, 3 cases of shoulder instability, 3 cases of fracture of the greater tuberosity of the humerus, and 2 cases of frozen shoulder. The basic information of the patients, ASES and VAS scores in each period before and after surgery, cardiac index (CI) and pulse pressure variation (PPV) before and after anesthesia, and changes in arm circumference and deltoid muscle circumference before and after surgery were recorded and evaluated. Result: The preoperative CI was affected by changes in anesthesia status and body position, while PPV is not affected by anesthesia and body position. Multivariate mixed-effects model analysis of CI found that there was a statistically significant difference between patients older than 55 years old and those with obesity (BMI>24). After the operation, the retention of irrigation fliud had an effect on the circumference of the deltoid, neck and arm, but the effect on the circumference of the deltoid was statistically significant (P<0.001 (95%CI: [0.30, 1.00]). The multivariate analysis of ASES scores at 3 and 6 months after surgery showed that the fluid retention volume was correlated with the ASES score at 3 months after surgery, especially when the retention volume was greater than 2L (P=0.001 (95%). %CI: [-12.49,-3.22]). Conclusion: The retention of irrigation fliud after shoulder arthroscopic surgery causes swelling of local limbs, and also has a certain effect on peripheral blood vessels, which is mainly reflected in its influence on PPV and the postoperation function. Therefore, the surgeon needs to improve the surgical technique, shorten the operation time and reduce the fluid retention.