Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery

TLDR

Perioperative fluid management remains controversial, with no consensus on optimal strategy. The study prospectively compared liberal versus restrictive intraoperative fluid protocols to assess their effect on postoperative outcomes in 152 elective intraabdominal surgery patients. Patients were randomized to receive either a liberal protocol (10 ml/kg bolus then 12 ml/kg/h) or a restrictive protocol (4 ml/kg/h) of lactated Ringer’s, with the primary endpoint being postoperative morbidity or mortality. The restrictive protocol reduced complications, accelerated return of bowel function, shortened hospital stay, limited fluid overload, and preserved hematocrit and albumin levels compared to the liberal protocol.

Abstract

The debate over the correct perioperative fluid management is unresolved.The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml x kg(-1) x h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml x kg(-1) x h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days.The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P < 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P < 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P < 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG.In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.