Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery

Area of Science:

• Anesthesiology
• Surgical Critical Care
• Nephrology

Background:

• Current guidelines suggest restrictive intravenous-fluid administration for enhanced recovery after major abdominal surgery.
• However, evidence supporting this strategy is limited, raising concerns about potential impairment of organ perfusion.

Purpose of the Study:

• To investigate the efficacy and safety of a restrictive versus a liberal intravenous-fluid regimen in patients undergoing major abdominal surgery.
• To determine the impact on disability-free survival and key secondary outcomes like acute kidney injury and septic complications.

Main Methods:

• A pragmatic, international randomized trial involving 3000 high-risk patients undergoing major abdominal surgery.
• Patients were assigned to either a restrictive or liberal intravenous-fluid regimen during and up to 24 hours post-surgery.
• The primary outcome was disability-free survival at 1 year, with secondary outcomes including acute kidney injury, renal-replacement therapy, and septic complications.

Main Results:

• The restrictive fluid group received a median of 3.7 liters of intravenous fluid, compared to 6.1 liters in the liberal group.
• Disability-free survival at 1 year was similar between groups (81.9% vs. 82.3%).
• The restrictive group showed a higher incidence of acute kidney injury (8.6% vs. 5.0%), surgical-site infections (16.5% vs. 13.6%), and renal-replacement therapy (0.9% vs. 0.3%).

Conclusions:

• A restrictive intravenous-fluid regimen was not associated with improved disability-free survival compared to a liberal regimen in high-risk patients undergoing major abdominal surgery.
• The restrictive strategy was associated with a higher rate of acute kidney injury and showed trends toward increased surgical-site infections and renal-replacement therapy.