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.
Clinical Unit of Preventive Medicine and Health Promotion, H:S Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. bbrandstrup@hotmail.com
Birgitte
B
Brandstrup
Hanne
H
Tønnesen
Randi
R
Beier-Holgersen
Else
E
Hjortsø
Helle
H
Ørding
Karen
K
Lindorff-Larsen
Morten S
MS
Rasmussen
Charlotte
C
Lanng
Lene
L
Wallin
Lene H
LH
Iversen
Christina S
CS
Gramkow
Mette
M
Okholm
Tine
T
Blemmer
Poul-Erik
PE
Svendsen
Henrik H
HH
Rottensten
Birgit
B
Thage
Jens
J
Riis
Inge S
IS
Jeppesen
Dorthe
D
Teilum
Anne Mette
AM
Christensen
Ben
B
Graungaard
Frank
F
Pott
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