title: Perioperative Fluid Utilization Variability and Association With Outcomes: Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations.
abstract: OBJECTIVE
  To study current perioperative fluid administration and associated outcomes in common surgical cohorts in the United States.
  
  
  BACKGROUND
  An element of enhanced recovery care protocols, optimized perioperative fluid administration may be associated with improved outcomes; however, there is currently no consensus in the United States on fluid use or the effects on outcomes of this use.
  
  
  METHODS
  The study included all inpatients receiving colon, rectal, or primary hip or knee surgery, 18 years of age or older, who were discharged from a hospital between January 1, 2008 and June, 30 2012 in the Premier Research Database. Patient outcomes and intravenous fluid utilization on the day of surgery were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low day-of-surgery fluids with the likelihood of increased hospital length of stay (LOS), total costs, or postoperative ileus.
  
  
  RESULTS
  The study showed significant associations between high fluid volume given on the day of surgery with both increased LOS (odds ratio 1.10-1.40) and increased total costs (odds ratio 1.10-1.50). High fluid utilization was associated with increased presence of postoperative ileus for both rectal and colon surgery patients. Low fluid utilization was also associated with worse outcomes.
  
  
  CONCLUSIONS
  According to results from this review of current practice in US hospitals, fluid optimization would likely lead to decreased variability and improved outcomes.
authors.affiliation: *Department of Surgery, Duke University School of Medicine, Durham, NC †Department of Research Quintiles, Durham, NC ‡Department of Research Premier, Inc, Charlotte, NC §Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals National Institute of Health Research Biomedical Research Centre, London, UK.
authors.forename: Julie K M
authors.initials: JK
authors.lastname: Thacker
authors.forename: William K
authors.initials: WK
authors.lastname: Mountford
authors.forename: Frank R
authors.initials: FR
authors.lastname: Ernst
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Krukas
authors.forename: Michael Monty G
authors.initials: MM
authors.lastname: Mythen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D014481:United States