Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial.
OBJECTIVE
To investigate the effect of a restricted intravenous fluid regimen versus a standard regimen on complications after colorectal resection.


BACKGROUND
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.


CONCLUSIONS
The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.
Brandstrup
Birgitte
B
Clinical Unit of Preventive Medicine and Health Promotion, H:S Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. bbrandstrup@hotmail.com
Tønnesen
Hanne
H
Beier-Holgersen
Randi
R
Hjortsø
Else
E
Ørding
Helle
H
Lindorff-Larsen
Karen
K
Rasmussen
Morten S
MS
Lanng
Charlotte
C
Wallin
Lene
L
Iversen
Lene H
LH
Gramkow
Christina S
CS
Okholm
Mette
M
Blemmer
Tine
T
Svendsen
Poul-Erik
PE
Rottensten
Henrik H
HH
Thage
Birgit
B
Riis
Jens
J
Jeppesen
Inge S
IS
Teilum
Dorthe
D
Christensen
Anne Mette
AM
Graungaard
Ben
B
Pott
Frank
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D003082:Colectomy; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D017673:Sodium Chloride, Dietary; D014867:Water
D017673:Sodium Chloride, Dietary; D014867:Water