Perioperative intravenous fluid prescribing: a multi-centre audit

Area of Science:

• Anesthesiology and Perioperative Medicine
• Surgical Outcomes Research
• Clinical Practice Audit

Background:

• Perioperative intravenous fluid administration guidelines exist but often conflict with established practices.
• Clinical practice and prescriber knowledge can influence fluid therapy decisions.
• Electrolyte disturbances are a common concern in postoperative patients.

Purpose of the Study:

• To audit intraoperative and postoperative intravenous fluid therapy practices across multiple centers.
• To investigate the frequency of postoperative electrolyte disturbances.
• To identify variations in fluid administration during and after surgery.

Main Methods:

• Retrospective audit of adult patients undergoing major elective surgery in five hospitals.
• Analysis of fluid and electrolyte administration during surgery and for three days postoperatively.
• Review of clinical records to assess electrolyte disturbances.

Main Results:

• Balanced crystalloids were commonly used intraoperatively and postoperatively.
• Significant variability in intraoperative fluid volumes was observed for common procedures.
• Postoperative intravenous fluid administration often exceeded recommended sodium levels and was inadequate in potassium, with frequent hypokalemia and hyponatremia.

Conclusions:

• Early oral fluid intake and cessation of intravenous fluids postoperatively align with enhanced recovery programs.
• Excessive sodium and inadequate potassium in postoperative intravenous fluids require further investigation.
• Variability in intraoperative fluid administration highlights the need for standardized protocols and future research encompassing both intraoperative and postoperative phases.