title: Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery.
abstract: INTRODUCTION Recent studies have advocated the use of perioperative fluid restriction in patients undergoing major abdominal surgery as part of an enhanced recovery protocol. Series reported to date include a heterogenous group of high- and low-risk procedures but few studies have focused on rectal cancer surgery alone. The aim of this study was to assess the effects of perioperative fluid volumes on outcomes in patients undergoing elective rectal cancer resection. METHODS A prospectively maintained database of patients with rectal cancer who underwent elective surgery over a 2-year period was reviewed. Total volume of fluid received intraoperatively was calculated, as well as blood products required in the perioperative period. The primary outcome was postoperative morbidity (Clavien-Dindo grade I-IV) and the secondary outcomes were length of stay and major morbidity (Clavien-Dindo grade III-IV). RESULTS Over a 2-year period (2012-2013), 120 patients underwent elective surgery with curative intent for rectal cancer. Median total intraoperative fluid volume received was 3680ml (range 1200-9670ml); 65/120 (54.1%) had any complications, with 20/120 (16.6%) classified as major (Clavien-Dindo grade III-IV). Intraoperative volume >3500ml was an independent risk factor for the development of postoperative all-cause morbidity (P=0.02) and was associated with major morbidity (P=0.09). Intraoperative fluid volumes also correlated with length of hospital stay (Pearson's correlation coefficient 0.33; P<0.01). CONCLUSIONS Intraoperative fluid infusion volumes in excess of 3500ml are associated with increased morbidity and length of stay in patients undergoing elective surgery for rectal cancer.
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital , Dublin , Ireland.
authors.forename: M R
authors.initials: MR
authors.lastname: Boland
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital , Dublin , Ireland.
authors.forename: I
authors.initials: I
authors.lastname: Reynolds
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital , Dublin , Ireland.
authors.forename: N
authors.initials: N
authors.lastname: McCawley
authors.affiliation: Department of Anaesthesia, Beaumont Hospital , Dublin 9 , Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Galvin
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital , Dublin , Ireland.
authors.forename: S
authors.initials: S
authors.lastname: El-Masry
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital , Dublin , Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Deasy
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital , Dublin , Ireland.
authors.forename: D A
authors.initials: DA
authors.lastname: McNamara
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cancer; Fluid; Intravenous; Perioperative; Rectal; Surgery