{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T11:23:32Z","timestamp":1774351412259,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","award":["20 0245 P 03H"],"award-info":[{"award-number":["20 0245 P 03H"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","award":["23 0627 JCIA"],"award-info":[{"award-number":["23 0627 JCIA"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011727","name":"Stockholm l\u00e4ns landsting","doi-asserted-by":"publisher","award":["20200004"],"award-info":[{"award-number":["20200004"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011727","name":"Stockholm l\u00e4ns landsting","doi-asserted-by":"publisher","award":["FoUI\u2010973310"],"award-info":[{"award-number":["FoUI\u2010973310"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007232","name":"Radiumhemmets Forskningsfonder","doi-asserted-by":"publisher","award":["194142"],"award-info":[{"award-number":["194142"]}],"id":[{"id":"10.13039\/501100007232","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","award":["SLS\u2010972109"],"award-info":[{"award-number":["SLS\u2010972109"]}],"id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011924","name":"European Society of Anaesthesiology","doi-asserted-by":"publisher","award":["ESAIC_GR_2020_EH"],"award-info":[{"award-number":["ESAIC_GR_2020_EH"]}],"id":[{"id":"10.13039\/501100011924","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Reliable data on optimal fluid management in the perioperative period for patients with advanced ovarian cancer undergoing cytoreductive surgery is limited. These patients often present with malignant ascites and are prone to significant fluid shifts perioperatively. For this reason, our objective was to define clinical targets for optimal fluid balance and determine whether initial ascites should be included in fluid\u2010loss calculations by examining the association between perioperative fluid balance and major postoperative complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective, observational study conducted in a centralized and public healthcare system setting in Sweden between 2020 and 2023 included patients with advanced ovarian cancer, &gt;\u200918\u2009years of age, scheduled for upfront cytoreductive surgery, an ASA physical status I\u2013III with no speech\/language issues. The primary outcome was major postoperative complication within 30\u2009days of surgery. The measurements of fluid input and output, cut\u2010offs for fluid balance, perioperative time, and postoperative complications were defined a priori. The association between fluid balance and major postoperative complications was assessed by multivariable regression, adjusted for predefined covariates, yielding odds ratios (OR) with 95% confidence intervals (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 175 enrolled patients, 162 were included in the final analysis. In the adjusted analysis, there was a significant association between fluid balance of 1750\u20132700\u2009mL, OR 3.40 (95% CI 1.06\u201310.9; <jats:italic>p<\/jats:italic>\u2009=\u20090.04) and &gt;\u20092700\u2009mL, OR 3.91 (95% CI 1.33\u201311.5; <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and major postoperative complications. When including initial ascites as fluid loss, a balance of &gt;\u20092700\u2009mL was associated with major postoperative complications, OR 2.59 (95% CI 1.01\u20136.66, <jats:italic>p<\/jats:italic>\u2009=\u20090.047).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>An optimal target for perioperative fluid balance to decrease the odds of major postoperative complications is suggested to be &lt;\u20091750\u2009mL. If initial ascites is included as loss in the calculation of balance, the optimal target of fluid balance is suggested to be &lt;\u20092700\u2009mL. These results provide practical clinical reference values that may assist anesthesiologists and surgical teams in optimizing perioperative fluid management in advanced ovarian cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Editorial Comment<\/jats:title><jats:p>This secondary analysis of a trial ovarian cancer operative cohort assessed the relation of the estimated fluid balance over the operative day 24\u2009h to major postoperative complications. The findings showed that the groups where the fluid balance was in the categories higher and also most positive had higher odds for having a major complication compared to the group with lowest fluid balance. Ascities fluid was an issue in this cohort, which was managed in the analysis.<\/jats:p><jats:p><jats:bold>Trial Registration:<\/jats:bold> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>: NCT04065009<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.70112","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T09:01:24Z","timestamp":1756198884000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prospective Assessment of Clinically Relevant Fluid Balance Thresholds Associated With Postoperative Complications in Advanced Ovarian Cancer"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2968-2733","authenticated-orcid":false,"given":"Emma","family":"Hasselgren","sequence":"first","affiliation":[{"name":"Department of Physiology and Pharmacology, Division of Anesthesiology Karolinska Institutet, and Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina Groes","family":"Kofoed","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrik","family":"Falconer","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e5kan","family":"Bj\u00f6rne","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, Division of Anesthesiology Karolinska Institutet, and Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Zach","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5498-163X","authenticated-orcid":false,"given":"Daniel","family":"Hunde","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemming","family":"Johansson","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2010Pathology Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2130-5132","authenticated-orcid":false,"given":"Mihaela","family":"Asp","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Division of Obstetrics and Gynaecology Lund University, and Department of Obstetrics and Gynaecology, Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Thorlacius","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Division of Anesthesia and Intensive Care Lund University, and Department of Anesthesia and Intensive Care Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e4ivi","family":"Kannisto","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Division of Obstetrics and Gynaecology Lund University, and Department of Obstetrics and Gynaecology, Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar","family":"Salehi","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-016-0154-3"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002220"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1808424"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2013.07.086"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2015.10.025"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002108"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2016.11.022"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2012.07.023"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2020.04.07"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0029665110001734"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-1987-8"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2016.10.027"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2021.02.034"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2024.10.015"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.10.495"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1308\/147870805X28127"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-021-03629-y"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1772-0"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1801601"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2019-000356"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2023.04.009"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0000000000000981"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13741-021-00235-y"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2023.07.007"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdq708"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2023-004355"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.833273"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002603"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.70112","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T06:22:42Z","timestamp":1758954162000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.70112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":30,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/aas.70112"],"URL":"https:\/\/doi.org\/10.1111\/aas.70112","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"value":"0001-5172","type":"print"},{"value":"1399-6576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,26]]},"assertion":[{"value":"2025-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70112"}}