Perioperative fluid retention and clinical outcome in elective, high-risk colorectal surgery

There is some controversy regarding concepts currently propagated for an optimal perioperative fluid management in colorectal surgery. We wanted to analyze the association of net intraoperative and postoperative fluid balances with postoperative morbidity and length of stay.

We performed a retrospective analysis of data collected prospectively from March 1993 through February 2005. A subgroup from 4,658 patients was studied who had undergone major elective colorectal surgery during that time. This subgroup included 198 patients with a particularly high preoperative risk profile requiring immediate postoperative intensive care unit (ICU) admission. Fluid therapy was guided by established clinical end points. Results were adjusted for various confounding variables (extent of the operative trauma, individual response to the injury, type of analgesia, underlying disease, treatment era).

After adjustment for relevant covariates, the magnitude of fluid balance was unimportant for morbidity and postoperative hospital length of stay. A high Apache II score after ICU admission, an increased perioperative blood loss, and palliative surgical procedures were associated with a significantly higher complication rate, whereas use of epidural analgesia improved morbidity and shortened hospital stay.

If guided by established standards, even large perioperative fluid retentions do not appear to be associated with a worse outcome after extended colorectal surgery. Epidural analgesia may provide a significant benefit in those high-risk patients.