Abstract
Excess intravenous water and sodium may be associated with postoperative complications and an adverse outcome. However, the effect of the magnitude of the surgery on such a relation has not been studied. This study assesses current practice in intravenous fluid and sodium administration after colonic and rectal resection and its relation to the postoperative outcome. A series of 100 consecutive patients undergoing elective colonic (n = 44) or rectal resection (n = 56) were included in a retrospective case-cohort study. The volumes of water and sodium from intravenous fluid and antibiotic administration on the day of surgery and the next 5 days were recorded together with the clinical outcome. The mean ± SEM fluid and sodium administration on the day of operation was greater after rectal than colonic resection (4.6 ± 0.2 vs. 3.6 ± 0.2 liters and 507 ± 34 vs. 389 ± 22 mmol, respectively (p < 0.05). The mean ± SEM rate of daily fluid and sodium administration for the 5 subsequent days was greater following rectal than colonic resection (2.1 ± 0.1 vs. 1.8 ± 0.1 L/day and 155 ± 8.7 vs. 128 ± 8.0 mmol/day; p < 0.05). For all resections, there were no differences in fluid and sodium administration on the day of surgery in patients with or without postoperative complications. During the subsequent 5days, patients with complications after colonic resection had a higher postoperative mean rate of intravenous sodium administration than those who did not (149 ± 12 vs. 115 ± 10 mmol; p < 0.05). A similar pattern was not observed following rectal resection. Current postoperative intravenous fluid prescription delivers approximately 2 liters of fluid and 140 mmol of sodium per day. Complications after colonic, but not rectal, resection are associated with more early postoperative daily intravenous sodium administration. Because colonic resection poses less of a physiologic insult than rectal resection, the overall outcome in the former group may be more sensitive to the interplay between fluid and sodium overload and patient co-morbidity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
DN Lobo MG Dube KR Neal et al. (2001) ArticleTitleProblems with solutions: drowning in the brine of an inadequate knowledge base Clin. Nutr. 20 125–130 Occurrence Handle10.1054/clnu.2000.0154 Occurrence Handle1:STN:280:DC%2BD3MnjsFSgsg%3D%3D Occurrence Handle11327739
DN Lobo KA Bostock KR Neal et al. (2002) ArticleTitleEffect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial Lancet 359 1812–1818 Occurrence Handle10.1016/S0140-6736(02)08711-1 Occurrence Handle12044376
JA Lowell C Schifferdecker DF Driscoll et al. (1990) ArticleTitlePostoperative fluid overload: not a benign problem Crit. Care Med. 18 728–733 Occurrence Handle1:STN:280:By%2BA3crkvFc%3D Occurrence Handle2364713
A Frost CH Wakefield F Sengupta et al. (2001) ArticleTitleRelationship between fluid administration and outcome in colorectal surgery Proc. Nutr. Soc. 60 113A
DR Prytherch MS Whiteley B Higgins et al. (1998) ArticleTitlePOSSUM and Portsmouth POSSUM for predicting mortality Br. J. Surg. 85 1217–1220 Occurrence Handle10.1046/j.1365-2168.1998.00840.x Occurrence Handle1:STN:280:DyaK1cvitlOrtw%3D%3D Occurrence Handle9752863
O Boyd RM Grounds ED Bennett (1993) ArticleTitleA randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients J. A. M. A. 22 2699–2707
T Shires J Williams F Brown (1961) ArticleTitleAcute changes in extracellular fluids associated with major surgical procedures Ann. Surg. 154 803–810 Occurrence Handle1:STN:280:CC2C3czntVU%3D Occurrence Handle13912109
K Holte NE Sharrock H Kehlet (2002) ArticleTitlePathophysiology and clinical implications of perioperative fluid excess Br. J. Anaesth. 89 622–632 Occurrence Handle10.1093/bja/aef220 Occurrence Handle1:STN:280:DC%2BD38njs1entg%3D%3D Occurrence Handle12393365
Callum KG, Gray AJG, Hoile RW, et al. Extremes of Age: The 1999 Report of the National Confidential Enquiry into Perioperative Deaths, London, National Confidential Enquiry into Perioperative Deaths (NCEPOD), 1999
FA Coler KN Campbell HH Vaughan et al. (1944) ArticleTitlePostoperative salt intolerance Ann. Surg. 119 533–541
AW Wilkinson BH Billing G Nagy et al. (1949) ArticleTitleExcretion of chloride and sodium after surgical operations Lancet 1 640–644 Occurrence Handle10.1016/S0140-6736(49)91741-9
B Brandstrup H Tonnesen R Beier-Holgerson et al. (2003) ArticleTitleEffects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens Ann. Surg. 238 641–648 Occurrence Handle10.1097/01.sla.0000094387.50865.23 Occurrence Handle14578723
K Lang J Boldt S Suttner et al. (2001) ArticleTitleColloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery Anesth. Analg. 93 405–409 Occurrence Handle10.1097/00000539-200108000-00034 Occurrence Handle1:STN:280:DC%2BD3MvislSksQ%3D%3D Occurrence Handle11473870
NJ Wilkes R Woolf M Mutch et al. (2001) ArticleTitleThe effects of balances versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients Anesth. Analg. 93 811–816 Occurrence Handle10.1097/00000539-200110000-00003 Occurrence Handle1:CAS:528:DC%2BD3MXnslKmurs%3D Occurrence Handle11574338
Author information
Authors and Affiliations
Corresponding author
Additional information
Alasdair B. MacGregor died after this study was completed.
Rights and permissions
About this article
Cite this article
Tambyraja, A., Sengupta, F., MacGregor, A. et al. Patterns and Clinical Outcomes Associated with Routine Intravenous Sodium and Fluid Administration after Colorectal Resection. World J. Surg. 28, 1046–1052 (2004). https://doi.org/10.1007/s00268-004-7383-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-004-7383-7