Intraoperative fluid restriction predicts improved outcomes in major vascular surgery.
BACKGROUND
Traditional fluid resuscitation during general anesthesia has been questioned in recent studies. One study of patients undergoing abdominal surgery showed decreased postoperative weight gain, earlier return of bowel function, and shorter intensive care unit (ICU) and hospital length of stay (LOS) when intraoperative crystalloid infusion was restricted. The authors conducted a retrospective study of major vascular surgery patients (neo-aorto iliac system surgery) to correlate clinical outcomes with intraoperative crystalloid fluid administration.


METHODS
The charts of 41 patients who underwent major vascular surgery at our institution were reviewed. Patients were grouped according to the crystalloid volume infused intraoperatively into <3 L (group 1) and >3 L (group 2). Preoperative and postoperative weights, intraoperative crystalloid administration, intraoperative vasopressor use, preoperative and postoperative creatinine, number of days to clear liquid diet, and the time to discharge from the ICU (ICU LOS) and hospital (hospital LOS) were collected.


RESULTS
There were statistically significant differences in duration of mechanical ventilation (0.55 +/- 0.934 vs 2.03 +/- 2.735 days, P = .013) and ICU LOS (3.0 +/- 1.48 vs 5.79 +/- 3.938, P = .029) in favor of the fluid restriction group. Major postoperative complications, such as sepsis, acute myocardial infarction, and graft thrombosis, were less frequent in the fluid restriction group but not statistically significant (5 vs 9, P = .742). Intraoperative crystalloid volume was found to be an independent predictor of ICU LOS after adjusting for estimated blood loss and duration of surgery. There was no statistically significant difference in preoperative serum albumin in both groups.


CONCLUSIONS
Restricted intraoperative administration of crystalloid fluids (<3 L) may be beneficial in major vascular surgery patients. These benefits are similar to those previously described in patients undergoing abdominal surgery.
Adesanya
Adebola
A
Department of Anesthesiology, University of Texas Southwestern Medical Center at Dallas, Dallas , USA. adebola.adesanya@utsouthwestern.edu
Rosero
Eric
E
Timaran
Carlos
C
Clagett
Patrick
P
Johnston
William E
WE
D000368:Aged; D001011:Aorta / Q000601:surgery*; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007362:Intensive Care Units; D007430:Intraoperative Care; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015532:Rehydration Solutions / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014680:Veins / Q000637:transplantation
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D015532:Rehydration Solutions