Fluid Therapy and Surgical Outcomes in Elective Surgery: A Need for Reassessment in Fast-Track Surgery

Abstract

Principles in perioperative fluid management and their implications for outcomes in elective surgery are controversial because there are limited data from randomized studies. ¹ Holte K. Sharrock N.E. Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002; 89 : 622-632 Crossref PubMed Scopus (443) Google Scholar ^{,  2} Grocott M.P. Mythen M.G. Gan T.J. Perioperative fluid management and clinical outcomes in adults. Anesth Analg. 2005; 100 : 1093-1106 Crossref PubMed Scopus (306) Google Scholar Although numerous previous studies and several systematic reviews have compared different types of fluids for resuscitation, the results so far have been inconclusive. ³ Roberts I. Alderson P. Bunn F. et al. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004; ( CD000567) Google Scholar ^{,  4} Alderson P. Bunn F. Lefebvre C. et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev. 2004; ( CD001208) Google Scholar ^{,  5} Bunn F. Roberts I. Tasker R. Akpa E. Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004; ( CD002045) Google Scholar ^{,  6} Zavrakidis N. Intravenous fluids for abdominal aortic surgery. Cochrane Database Syst Rev. 2000; ( CD000991) Google Scholar ^{,  7} Bunn F. Alderson P. Hawkins V. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2003; ( CD001319) Google Scholar ^{,  8} Choi P.T. Yip G. Quinonez L.G. Cook D.J. Crystalloids vs. colloids in fluid resuscitation a systematic review. Crit Care Med. 1999; 27 : 200-210 Crossref PubMed Scopus (491) Google Scholar Importantly, the vast majority of studies included in these reviews focused on critically ill patients, with conclusions not necessarily applicable for patients undergoing elective surgical procedures. Recent data suggest that not only the type of fluid, but also the amount of fluid administered perioperatively may influence surgical outcomes, ¹ Holte K. Sharrock N.E. Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002; 89 : 622-632 Crossref PubMed Scopus (443) Google Scholar ^{,  2} Grocott M.P. Mythen M.G. Gan T.J. Perioperative fluid management and clinical outcomes in adults. Anesth Analg. 2005; 100 : 1093-1106 Crossref PubMed Scopus (306) Google Scholar ^{,  9} Joshi G.P. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg. 2005; 101 : 601-605 Crossref PubMed Scopus (154) Google Scholar ^{,  10} Nisanevich V. Felsenstein I. Almogy G. et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005; 103 : 25-32 Crossref PubMed Scopus (583) Google Scholar ^{,  11} Brandstrup B. Tonnesen H. Beier-Holgersen R. et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003; 238 : 641-648 Crossref PubMed Scopus (1145) Google Scholar ^{,  12} Holte K. Klarskov B. Christensen D.S. et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy a randomized, double-blind study3368. Ann Surg. 2004; 240 : 892-899 Crossref PubMed Scopus (213) Google Scholar a factor not often recognized in previous studies on perioperative fluid management. Recent data have demonstrated that a multimodal revision of principles for postoperative care may improve outcomes after major surgical procedures (eg, fast-track surgery), ¹³ Kehlet H. Dahl J.B. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003; 362 : 1921-1928 Abstract Full Text Full Text PDF PubMed Scopus (913) Google Scholar ^{,  14} Basse L. Hjort J.D. Billesbolle P. et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg. 2000; 232 : 51-57 Crossref PubMed Scopus (601) Google Scholar ^{,  15} Basse L. Thorbol J.E. Lossl K. Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum. 2004; 47 : 271-278 Crossref PubMed Scopus (340) Google Scholar findings that might also have implications for fluid management practices.