Perioperative fluid management: prospective audit

Int J Clin Pract. 2008 Mar;62(3):492-7. doi: 10.1111/j.1742-1241.2007.01386.x. Epub 2007 May 30.


Background: Postoperative fluid management is a core surgical skill but there are few data regarding current fluid management practice and the incidence of potential fluid-related complications in general surgical units. We conducted a prospective audit of postoperative fluid management and fluid-related complications in a consecutive cohort of patients undergoing midline laparotomy.

Methods: Over a 6-month period, the peri-operative fluid management of 106 consecutive patients was prospectively audited. Serum electrolyte data, fluid balance data, co-morbidities, operative and anaesthetic variables and quantities of fluid and electrolytes prescribed were recorded. The development of fluid-related and other complications was noted.

Results: There were no correlations between routinely available fluid balance parameters and the quantities of fluid and electrolytes prescribed, suggesting that doctors do not consult fluid balance data when prescribing. Fifty-seven patients (54%) developed at least one fluid-related complication. These patients received significantly greater volumes of fluid and sodium each day postoperatively. They had higher rates of other non-fluid-related complications and death. They had a longer hospital stay. In a multivariate model, mean daily fluid load predicted the development of fluid-related complications.

Conclusion: Fluid prescription practice in general surgical units is sub-optimal, resulting in avoidable iatrogenic complications. Involvement of senior staff, education and possibly the introduction of prescribing protocols may improve the situation.

MeSH terms

  • Cohort Studies
  • Electrolytes
  • Female
  • Fluid Therapy / methods
  • Fluid Therapy / standards*
  • Humans
  • Laparotomy
  • Male
  • Medical Audit
  • Monitoring, Physiologic / methods*
  • Perioperative Care / methods
  • Perioperative Care / standards*
  • Professional Practice
  • Prospective Studies
  • Water-Electrolyte Balance


  • Electrolytes