title: Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized, clinical trials.
abstract: BACKGROUND
  Fluid management is a fundamental component of surgical care. Recently, there has been considerable interest in perioperative fluid restriction as a method of facilitating recovery following elective major surgery. A number of randomized trials have addressed the issue in various surgical specialities, and a recent meta-analysis proposed uniform definitions regarding fluid amount as well as examining fluid restriction in patients undergoing colonic resection.
  
  
  METHODS
  Medline, Embase, trial registries, conference proceedings, and article reference lists were searched to identify randomized, controlled trials of perioperative fluid restriction versus "standard" perioperative fluid management, as per definitions formulated previously. All of the studies involved patients undergoing colonic resection. The primary outcome measure was postoperative morbidity. Secondary endpoints included mortality, renal failure, time to first flatus, and length of hospital stay. A random effects model was applied.
  
  
  RESULTS
  Seven randomized, controlled trials with a total of 856 patients investigating standard versus restrictive fluid regimes, as denoted by the definitions, were included. Perioperative fluid restriction had no effect on the risk of postoperative complications (OR 0.49 (95 % confidence interval (CI) 0.2-1.18; P = 0.101). There was no detectable effect on death and fluid restriction did not reduce hospital stay (Pooled weighted mean difference -0.25; 95 % CI 0.72-0.21; P = 0.29).
  
  
  CONCLUSIONS
  Perioperative fluid restriction does not significantly reduce the risk of complications following major abdominal surgery. Furthermore, it does not appear to reduce length of hospital stay.
authors: Mid-Western Vascular Unit, Mid-Western Regional Hospital, Limerick, Ireland. mickyboland@gmail.com
authors: Michael R
authors: MR
authors: Boland
authors: Ayesha
authors: A
authors: Noorani
authors: Kevin
authors: K
authors: Varty
authors: J Calvin
authors: JC
authors: Coffey
authors: Riaz
authors: R
authors: Agha
authors: Stewart R
authors: SR
authors: Walsh
mesh_terms: D000005:Abdomen / Q000601:surgery*; D017558:Elective Surgical Procedures; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic