Abstract
Background
Fluid management is a fundamental component of surgical care. Recently, there has been considerable interest in perioperative fluid restriction as a method of facilitating recovery following elective major surgery. A number of randomized trials have addressed the issue in various surgical specialities, and a recent meta-analysis proposed uniform definitions regarding fluid amount as well as examining fluid restriction in patients undergoing colonic resection.
Methods
Medline, Embase, trial registries, conference proceedings, and article reference lists were searched to identify randomized, controlled trials of perioperative fluid restriction versus “standard” perioperative fluid management, as per definitions formulated previously. All of the studies involved patients undergoing colonic resection. The primary outcome measure was postoperative morbidity. Secondary endpoints included mortality, renal failure, time to first flatus, and length of hospital stay. A random effects model was applied.
Results
Seven randomized, controlled trials with a total of 856 patients investigating standard versus restrictive fluid regimes, as denoted by the definitions, were included. Perioperative fluid restriction had no effect on the risk of postoperative complications (OR 0.49 (95 % confidence interval (CI) 0.2–1.18; P = 0.101). There was no detectable effect on death and fluid restriction did not reduce hospital stay (Pooled weighted mean difference −0.25; 95 % CI 0.72–0.21; P = 0.29).
Conclusions
Perioperative fluid restriction does not significantly reduce the risk of complications following major abdominal surgery. Furthermore, it does not appear to reduce length of hospital stay.
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References
Tambyraja AL, Sengupta F, MacGregor AB, Bartolo DC, Fearon KC (2004) Patterns and clinical outcomes associated with routine intravenous sodium and fluid administration after colorectal resection. World J Surg 28(10):1046–1051. doi:10.1007/s00268-004-7383-7 discussion 1051–1052
Walsh SR, Walsh CJ (2005) Intravenous fluid-associated morbidity in postoperative patients. Ann R Coll Surg Engl 87(2):126–130
Walsh SR, Cook EJ, Bentley R, Farooq N, Gardner-Thorpe J, Tang T et al (2008) Perioperative fluid management: prospective audit. Int J Clin Pract 62(3):492–497
Moller AM, Pedersen T, Svendsen PE, Engquist A (2002) Perioperative risk factors in elective pneumonectomy: the impact of excess fluid balance. Eur J Anaesthesiol 19(1):57–62
Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR (1990) Postoperative fluid overload: not a benign problem. Crit Care Med 18(7):728–733
Lobo DN, Macafee DA, Allison SP (2006) How perioperative fluid balance influences postoperative outcomes. Best Pract Res Clin Anaesthesiol 20(3):439–555
Holte K, Sharrock NE, Kehlet H (2002) Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 89:622–632
Sear JW (2005) Kidney dysfunction in the postoperative period. Br J Anaesth 95(1):20–32
Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809
McArdle GT, McAuley DF, McKinley A, Blair P, Hoper M, Harkin DW (2009) Preliminary results of a prospective randomised trial of restrictive versus standard fluid regime in elective open abdominal aortic aneurysm repair. Ann Surg 250(1):28–34
Boldt J (2006) Fluid management of patients undergoing abdominal surgery—more questions than answers. Eur J Anaesthesiol 23:631–640
Holte K, Kehlet H (2006) Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg 202:971–989
Rahbari NN, Zimmermann JB, Schmidt T, Koch M, Weigand MA, Weitz J (2009) Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 96(4):331–341
Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 359(9320):1812–1818
Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238:641–648
Mackay G, Fearon K, McConnachie A, Serpell MG, Molloy RG, O’Dwyer PJ (2006) Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery. Br J Surg 93(12):1469–1474
Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I (2005) Effect of intraoperative fluid management on outcome after intra-abdominal surgery. Anesthesiology 103(1):25–32
Holte K, Foss NB, Andersen J, Valentiner L, Lund C, Bie P et al (2007) Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anaesth 99:500–508
Kabon B, Akca O, Taguchi A, Nagele A, Jebadurai R, Arkilic CF et al (2005) Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection. Anesth Analg 101:1546–1553
Miller RD (ed) (2005) Miller’s anesthesia, 6th edn. Elsevier, Philadelphia
Higgins JPT, Green S (eds) (2009) Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12
Der Simonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Abraham-Nordling M, Hjern F, Pollack J, Prytz M, Borg T, Kressner U (2012) Randomized clinical trial of fluid restriction in colorectal surgery. Br J Surg 99(2):186–191
Vermeulen H, Hofland J, Legemate DA, Ubbink DT (2009) Intravenous fluid restriction after major abdominal surgery: a randomized blinded clinical trial. Trials 10:50
Kalyan J, Rosbergen M, Pal N, Sargen K, Fletcher S, Nunn D, Clark A, Williams M, Lewis M. A prospective randomised observer blinded controlled trial of fluid and salt restriction in elective gastrointestinal surgery (Abstract)
Varadhan KK, Lobo DN (2010) A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right. Proc Nutr Soc 69:488–498
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Boland, M.R., Noorani, A., Varty, K. et al. Perioperative Fluid Restriction in Major Abdominal Surgery: Systematic Review and Meta-analysis of Randomized, Clinical Trials. World J Surg 37, 1193–1202 (2013). https://doi.org/10.1007/s00268-013-1987-8
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DOI: https://doi.org/10.1007/s00268-013-1987-8