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Perioperative Fluid Restriction in Abdominal Surgery: A Systematic Review and Meta-analysis

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Abstract

Background

Perioperative fluid management is a critical component in patients undergoing abdominal surgery. However, the benefit of restricted fluid regimen remains inconclusive. This systematic review aimed to explore potential factors causing these inconsistent findings.

Methods

The literature searches were performed in three databases including PubMed, Embase, and the Cochrane library until August 30, 2018. Only randomized, controlled trials comparing the effect of restricted versus liberal regimen in abdominal surgery were included. The primary outcome was total postoperative complications. Subgroup analysis was performed according to between-group weight increase difference (≥ 2 kg and < 2 kg) and fluid intake ratio (≥ 1.8 and < 1.8).

Results

Sixteen studies were finally included in this meta-analysis. The benefit of the restricted regimen in reducing postoperative complication was only significant in the subgroup with high weight increase difference (≥ 2 kg) (RR 0.67, 95% CI 0.57–0.79) and the subgroup with high fluid intake ratio (≥ 1.8) (RR 0.72, 95% CI 0.62–0.82). In the subgroup with low weight increase difference (< 2 kg) or low fluid intake ratio (< 1.8), the effect of the restricted regimen was not significant (RR 0.88, 95% CI 0.51–1.50, and RR 1.18, 95% CI 0.91–1.53, respectively).

Conclusions

The benefit of the restricted regimen was only significant in the subgroup with high weight increase difference (≥ 2 kg) or high fluid intake ratio (≥ 1.8).

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Funding

This meta-analysis received funding from Zhejiang Province health high-level talents and Zhejiang Province sepsis innovation subject during the language polishing.

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Authors and Affiliations

  1. Department of Intensive Care Unit, Zhejiang Hospital, No. 12, Linyin Road, Hangzhou, 310000, Zhejiang, People’s Republic of China

    Yanfei Shen, Guolong Cai, Shijin Gong & Jing Yan

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  1. Yanfei Shen
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  2. Guolong Cai
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  3. Shijin Gong
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Correspondence to Guolong Cai.

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Shen, Y., Cai, G., Gong, S. et al. Perioperative Fluid Restriction in Abdominal Surgery: A Systematic Review and Meta-analysis. World J Surg 43, 2747–2755 (2019). https://doi.org/10.1007/s00268-019-05091-y

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