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

Abstract

Objective: To investigate the effect of a restricted intravenous fluid regimen versus a standard regimen on complications after colorectal resection.

Summary background data: 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.

Methods: 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.

Results: 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.

Conclusion: The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.

FIGURE 1. Administered fluid and body weight changes. R marks the restricted group and S the standard group. Fluids are presented as summation of means. * P < 0.001. ^† P < 0.01. ^‡ “Other or unspecified” represents blood, albumin, and/or fresh frozen plasma on the day of operation. Type of intravenous fluids was not specified on postoperative day 1 to 6. Weight changes are compared with the weight the morning of operation.

FIGURE 2. Complication frequency related to intravenous fluid administration and body weight increase on the day of operation. P < 0.001 both for increasing intravenous fluid volume and increasing body weight (χ² test for trend).