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PERioperative Fluid Management in Elective ColecTomy (PERFECT)—a national prospective cohort study

A Correction to this article was published on 03 July 2019

This article has been updated

Abstract

Background

There is contradictory evidence regarding the merits of restricted versus liberal perioperative intravenous (IV) fluid administration in bowel surgery. This study sought to audit perioperative fluid management in elective colectomy in Ireland and to analyse the impact of such on operative outcomes.

Methods

A national surgical trainee collaborative audit of perioperative fluid management was performed. Data from each site was collected prospectively over a selected 3-week period within a pre-defined 2-month block. Collected variables included demographics, type of operation/anaesthethic, volume/type of fluid administration pre-, intra- and post-operatively, 30-day morbidity and mortality. Primary outcome was fluid balance 24-h post-operatively with further analysis to identify the impact of this on 30-day morbidity. ROC curves were generated to identify the critical volume at which fluid balance was associated with 30-day morbidity.

Results

Ninety-four patients were enrolled from 17 hospitals. Mean age was 64 years. A total of 48.9% (N = 46) were managed by ERAS and 51.1% (N = 48) received bowel preparation. Almost 70% of cases (N = 63) were completed by minimally invasive techniques. Significant 30-day morbidity requiring hospital readmission was low [6.4% (n = 6)]. Median fluid balance at 24 h was + 715 ml (IQR 165–1486 ml). On multivariate analysis, high BMI (p = 0.02), indication for surgery (p = 0.02) and critical care admission (p = 0.008) were significantly predictive of 30-day morbidity. Twenty-four hour fluid balance >+ 665 ml was associated with increased risk of 30-day morbidity on univariate but not multivariate analysis, implying association but not causation.

Conclusion

Overall, perioperative fluid management was within an acceptable range with minimal impact on 30-day morbidity following elective colorectal surgery.

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Change history

  • 03 July 2019

    The above article originally published with Christina Fleming and Irish Surgical Research Collaborative listed in the authorship line.

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Author information

Authors and Affiliations

Consortia

Ethics declarations

Ethical approval was sought prospectively from each regional clinical ethics committee prior to commencing data collection. Authorship was assigned in keeping with the Association of Surgeons in Training (ASiT)/National Research Collaborative (NRC) authorship model.

Conflict of interest

Nil

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The original version of this article was revised: The above article originally published with Christina Fleming and Irish Surgical Research Collaborative listed in the authorship line. Christina Fleming’s name was included in error by the Publisher, and should have instead been included in the Collaborators section.

Appendix

Appendix

Pre-operative  
MRN (for data collection only)  
Age (years)  
Gender  
ASA  
Indication  
Admission date  
Enhanced recovery (Y/N)  
Pre-op weight (kg)  
BMI  
Diabetic (Y/N)  
Baseline creatinine  
Baseline haemoglobin  
Baseline diuretic
  Type
  Dose
 
IV fluid preop
  Type
  Volume
 
Pre-op bowel prep (Y/N)
  Type
 
Intra-operative  
Date of surgery  
Time of induction  
Time of skin closure  
Lap/converted/open/robotic  
Operation  
Operation duration (min)  
General anaesthesia (Y/N)  
Spinal anaesthesia (Y/N)  
Epidural (Y/N)  
Cannula
  Size
  Number
 
Urinary catheter  
Goal-directed fluid therapy (Y/N)
  Type
 
Oesophageal Doppler use (Y/N)  
IV fluids
  Type
  Volume
 
Blood products
  Type
  Volume
 
Intra-op urinary output  
Intra-op blood loss (ml)  
Intra-op complications (Y/N)
  Type
 
Inotropes (Y/N)  
Post-op day 1  
POD1 fluid balance (ml)  
Total post op fluid input (ml)  
Total post op fluid output (ml)  
Weight (kg)  
IV fluid post op to 24 h
  Type
  Volume
 
Blood products post op to 24 h
  Type
  Volume
 
Enteral fluid input post-op to 24 h
  Tpye
  Volume
 
Urinary output POD-24 h (ml)  
GI output POD-24 h (ml)  
Stoma (Y/N)
  Volume POD-24 h
 
Creatinine day 1  
Post-op diuretic
  Type
  Dose
 
Post-op day 30  
HDU (Y/N)–planned (Y/N)  
ICU (Y/N)–planned (Y/N)  
Total LOS (days)  
High output stoma (Y/N)  
Renal compromise from HOS (Y/N)  
Return to theatre (Y/N)  
Time to return to oral fluids (POD)  
Time to return to oral diet (POD)  
Time to passing flatus (POD)  
Time to BO (POD)  
30-day morbidity (Y/N)  
Specific morbidity  
Clavien-Dindo grade  
Complication description  
All cause 30-day ED attendance  
All cause 30-day re-admission  
All cause 30-day mortality  
Cause of death  

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Irish Surgical Research Collaborative. PERioperative Fluid Management in Elective ColecTomy (PERFECT)—a national prospective cohort study. Ir J Med Sci 188, 1363–1371 (2019). https://doi.org/10.1007/s11845-019-02003-w

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Keywords

  • Colectomy
  • Collaborative research
  • Elective colectomy
  • IV fluids
  • Perioperative fluids
  • Trainee collaborative