Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality - Improving Standardized Practice

Area of Science:

• Anesthesiology
• Surgical Outcomes
• Nephrology

Background:

• Current intraoperative fluid management practices lack standardization.
• Limited national guidelines contribute to a quality gap in fluid administration.
• This study addresses the need for evidence-based fluid management protocols.

Purpose of the Study:

• To identify a safe intraoperative fluid volume range for elective colorectal surgery.
• To minimize postoperative complications including ileus, prolonged length of stay (LOS), and acute kidney injury (AKI).
• To establish optimal fluid management strategies to improve patient outcomes.

Main Methods:

• Retrospective analysis of 2900 elective colorectal surgery patients (2018-2020).
• Evaluation of the association between intraoperative fluid rates and volumes (Lactated Ringer's infusion) and postoperative complications.
• Logistic regression analysis to identify independent risk factors for complications, controlling for fluid volume.

Main Results:

• Total intraoperative fluid volume, not infusion rate, significantly impacted postoperative outcomes.
• A total fluid administration range of 300 mL to 2.7 L was linked to the lowest complication rates.
• Intraoperative fluid volumes ≥2.7 L were independently associated with increased risk of ileus and prolonged LOS, but not AKI.
• Fluid volumes ≤300 mL did not increase AKI risk.

Conclusions:

• Excessive intraoperative fluid administration (≥2.7 L) in elective colorectal surgery increases the risk of postoperative ileus and prolonged LOS.
• A total intraoperative fluid volume between 300 mL and 2.7 L appears to be a safe and effective range.
• Anesthesia planning should consider total fluid volume to optimize patient care and reduce complications.