Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens a randomized assessor-blinded multicenter trial

• Published in: Annals of surgery Vol. 238; no. 5; pp. 641 - 648
• Main Authors: BRANDSTRUP, Birgitte, TØNNESEN, Hanne, BEIER-HOLGERSEN, Randi, HJORTSØ, Else, ØRDING, Helle, LINDORFF-LARSEN, Karen, RASMUSSEN, Morten S, LANNG, Charlotte, WALLIN, Lene
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-11-2003
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Weight; Colectomy; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery; Female; Fluid Therapy - methods; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Perioperative Care; Postoperative Complications - prevention & control; Sodium Chloride, Dietary; Water; Human; Intensive cardiocirculatory care; Rectal disease; Intravenous administration; Multicenter study; Quantity; Surgical resection; Incidence; Colonic disease; Liquid; Randomization; Decrease; Surgery; Rectum; Digestive diseases; Intestinal disease; Complication; Clinical trial; Colon; Influence factor; Resuscitation
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/01.sla.0000094387.50865.23

To investigate the effect of a restricted intravenous fluid regimen versus a standard regimen on complications after colorectal resection.
Current fluid administration in major surgery causes a weight increase of 3-6 kg. Complications after colorectal surgery are reported in up to 68% of patients. Associations between postoperative weight gain and poor survival as well as fluid overload and complications have been shown.
We did a randomized observer-blinded multicenter trial. After informed consent was obtained, 172 patients were allocated to either a restricted or a standard intraoperative and postoperative intravenous fluid regimen. The restricted regimen aimed at maintaining preoperative body weight; the standard regimen resembled everyday practice. The primary outcome measures were complications; the secondary measures were death and adverse effects.
The restricted intravenous fluid regimen significantly reduced postoperative complications both by intention-to-treat (33% versus 51%, P = 0.013) and per-protocol (30% versus 56%, P = 0.003) analyses. The numbers of both cardiopulmonary (7% versus 24%, P = 0.007) and tissue-healing complications (16% versus 31%, P = 0.04) were significantly reduced. No patients died in the restricted group compared with 4 deaths in the standard group (0% versus 4.7%, P = 0.12). No harmful adverse effects were observed.
The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.