Perioperative fluid therapy in elective colectomy in an enhanced recovery programme

Abstract

Although intraoperative fluid restriction is thought to provide clinical benefits, it may not be suitable for patients with significant co-morbidities, who may ultimately require greater amounts of intravenous fluid (IVF) post-operatively. This study investigates whether intraoperative fluid restriction can be implemented uniformly in patients undergoing elective colectomy within an Enhanced Recovery after Surgery (ERAS) protocol and investigates the association between fluid administration and clinical outcomes. A retrospective review of prospectively collected data was conducted for all patients who underwent elective colectomy from September 2006 to 2010 within our ERAS programme. Patients received intraoperative fluid restriction with post-operative fluid administered as per clinical indications. Demographic data, American Society of Anaesthesiology (ASA) status, IVF administered and clinical outcomes were recorded. There were 227 patients (ASA 1: 47; ASA 2: 108; ASA 3: 72) with a median age of 71 years. Patients received a median of 2000 mL of crystalloid intraoperatively. There were no statistically significant differences between post-operative IVF amounts. Patients who experienced complications received significantly greater amounts of IVF post-operatively (5000 mL versus 2000 mL; P < 0.01) and post-operative IVF administration was the strongest predictor of complications in a logistic regression model. There was a trend suggesting higher median post-operative IVF prior to patients experiencing major complications (3000 mL versus 2000 mL; P= 0.07). Intraoperative fluid restriction can be employed uniformly in ASA 1-3 patients undergoing colectomy. Post-operative administration of greater fluid volumes was associated with adverse outcomes.