Perioperative fluid management: prospective audit

Postoperative fluid management is a core surgical skill but there are few data regarding current fluid management practice and the incidence of potential fluid-related complications in general surgical units. We conducted a prospective audit of postoperative fluid management and fluid-related complications in a consecutive cohort of patients undergoing midline laparotomy.

Over a 6-month period, the peri-operative fluid management of 106 consecutive patients was prospectively audited. Serum electrolyte data, fluid balance data, co-morbidities, operative and anaesthetic variables and quantities of fluid and electrolytes prescribed were recorded. The development of fluid-related and other complications was noted.

There were no correlations between routinely available fluid balance parameters and the quantities of fluid and electrolytes prescribed, suggesting that doctors do not consult fluid balance data when prescribing. Fifty-seven patients (54%) developed at least one fluid-related complication. These patients received significantly greater volumes of fluid and sodium each day postoperatively. They had higher rates of other non-fluid-related complications and death. They had a longer hospital stay. In a multivariate model, mean daily fluid load predicted the development of fluid-related complications.

Fluid prescription practice in general surgical units is sub-optimal, resulting in avoidable iatrogenic complications. Involvement of senior staff, education and possibly the introduction of prescribing protocols may improve the situation.