Abstract
Preoperative dehydration is usually found in 30–50% of surgical patients, but the incidence is unknown in the urologic population. We determined the prevalence of preoperative dehydration in major elective urological surgery and studied its association with postoperative outcome, with special attention to plasma creatinine changes. We recruited 187 patients scheduled for major abdominal urological surgery to participate in a single-center study that used the fluid retention index (FRI), which is a composite index of four urinary biomarkers that correlate with renal water conservation, to assess the presence of dehydration. Secondary outcomes were postoperative nausea and vomiting (PONV), return of gastrointestinal function, in-hospital complications, quality of recovery, and plasma creatinine. The proportion of dehydrated patients at surgery was 20.4%. Dehydration did not correlate with quality of recovery, PONV, or other complications, but dehydrated patients showed later defecation (p = 0.02) and significant elevations of plasma creatinine after surgery. The elevations were also greater when plasma creatinine had increased rather than decreased during the 24 h prior to surgery (p < 0.001). Overall, the increase in plasma creatinine at 6 h after surgery correlated well with elevations on postoperative days one and two. In conclusion, we found preoperative dehydration in one-fifth of the patients. Dehydration was associated with delayed defecation and elevated postoperative plasma creatinine. The preoperative plasma creatinine pattern could independently forecast more pronounced increases during the early postoperative period.
Highlights
The degree of preoperative dehydration and its relationship to postoperative outcome is unclear
Some studies show that preoperative dehydration increases the risk of overall postoperative complications, while others indicate a negative effect on morbidity, for example, by causing postoperative nausea and vomiting (PONV) [1,5]
Other studies have been unable to show these effects [10]. The objective of this observational study was to determine the prevalence of preoperative dehydration, as measured by the fluid retention index (FRI), among candidates for elective major urologic surgery and its relationship to postoperative outcome
Summary
The degree of preoperative dehydration and its relationship to postoperative outcome is unclear. The prevalence in the urologic population is not presently known, but it is relevant because an adequate fluid regime in the perioperative period might reduce complications [8,9]. Some studies show that preoperative dehydration increases the risk of overall postoperative complications, while others indicate a negative effect on morbidity, for example, by causing postoperative nausea and vomiting (PONV) [1,5]. Other studies have been unable to show these effects [10] The objective of this observational study was to determine the prevalence of preoperative dehydration, as measured by the fluid retention index (FRI), among candidates for elective major urologic surgery and its relationship to postoperative outcome. We collected data on the incidence of surgery-associated nausea and vomiting, postoperative return of gastrointestinal function, fluid balance, complications within hospitalization, quality of recovery, and renal function. Special emphasis was placed on the perioperative pattern of plasma creatinine
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