Intravenous fluid and electrolyte administration in elective gastrointestinal surgery: mechanisms of excessive therapy

• Published in: Annals of the Royal College of Surgeons of England 2017-07, Vol.99 (6), p.497-503
• Main Authors: Simpson, R G, Quayle, J, Stylianides, N, Carlson, G, Soop, M
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal surgery; Adults; Aged; Analgesia, Epidural; Anesthesia; Digestive System Surgical Procedures - statistics & numerical data; Elective Surgical Procedures - statistics & numerical data; Electrolytes; Electrolytes - administration & dosage; Electrolytes - therapeutic use; Fluid Therapy - adverse effects; Fluid Therapy - statistics & numerical data; Fluids; Gastrointestinal surgery; Hospitals, Teaching; Humans; Infusions, Intravenous; Laparoscopy; Lower GI surgery; Medical Audit; Middle Aged; Nutrition; Parenteral nutrition; Patients; Postoperative Complications; Practice Guidelines as Topic; Retrospective Studies; Surgical outcomes; Teaching hospitals; Urine
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2017.0077

INTRODUCTION While clinical guidelines stress the importance of the judicious perioperative intravenous fluid administration, data show that adherence to these protocols is poor. The reasons have not been identified. We therefore audited the magnitude and indications of fluid and electrolyte administration in a teaching hospital. We hypothesised that epidural analgesia is associated with excessive fluid therapy. MATERIALS AND METHODS Intravenous fluid and electrolyte administration during the day of surgery and the subsequent 2 days in consecutive patients undergoing elective gastrointestinal surgery between November 2013 and May 2014 were retrospectively audited. Timing, volumes and indications were recorded. RESULTS One hundred patients undergoing elective gastrointestinal resection were studied. Patients received 9030 ml ± 2860 ml (mean ± standard deviation) intravenous fluids containing a total of 1180 ml ± 420 mmol sodium and resulting in a cumulative fluid balance of +5120 ml ± 2510 ml; 44% ± 14% of total volumes were given in theatre. Nearly all fluid was given for maintenance, 100% (96-100%, interquartile range), with 17 patients only receiving replacement or resuscitation. Independent predictors of increased volumes included open surgery, upper gastrointestinal surgery, increased duration and epidural analgesia but not body weight. Postoperative fluid volume was the only independent predictor of postoperative complication grade (P = 0.0044). CONCLUSIONS Despite published guidelines, perioperative fluid and electrolyte administration were excessive and were associated with postoperative morbidity. Substantial volumes were administered in theatre. Nearly all administration was for maintenance, yet patients received approximately five times the amount of sodium required. Epidural analgesia was an independent predictor of fluid volumes but body weight was not.