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Updated: May 27, 2025

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Simplified Enhanced Recovery After Surgery Intraoperative Fluid Management.

Hilary Gallin1, Marcus V Ortega2, Rachel Sisodia3

  • 1Department of Anesthesiology, Weill Cornell School of Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.

The Journal of Surgical Research
|February 15, 2025
PubMed
Summary
This summary is machine-generated.

A simplified fluid metric of 500 mL/h in Enhanced Recovery After Surgery (ERAS) pathways effectively improves postoperative kidney function. This balanced approach reduces overhydration risks while ensuring adequate hydration for better patient outcomes.

Keywords:
ERASEfficiencyFluid managementMorbidity and mortalityPerioperative careRenal failureSurgery outcomes

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Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Nephrology
  • Surgical Critical Care

Background:

  • Enhanced Recovery After Surgery (ERAS) pathways aim to optimize patient recovery.
  • Intraoperative fluid management is crucial for postoperative outcomes, particularly kidney function.
  • Current fluid administration methods may lack standardization, potentially leading to suboptimal hydration or overhydration.

Purpose of the Study:

  • To evaluate the efficacy of a simplified intraoperative fluid administration metric (500 mL/h) within ERAS pathways.
  • To determine if this metric optimizes fluid management and improves postoperative kidney function.
  • To assess the impact of this metric on serum creatinine levels post-surgery.

Main Methods:

  • Retrospective evaluation of 1028 adult patients undergoing major abdominal surgeries (hysterectomy, colectomy, gastrectomy) within ERAS pathways.
  • Comparison of a proposed fluid metric (500 mL/h) against traditional fluid administration methods.
  • Analysis of serum creatinine changes and monitoring of compliance with the simplified fluid metric using statistical tests including quantile regression.

Main Results:

  • Patients receiving fluid volumes below the optimal range showed a median serum creatinine increase of 0.03 mg/dL.
  • Patients receiving fluid volumes above the optimal range showed a median serum creatinine increase of 0.01 mg/dL.
  • The simplified fluid metric demonstrated a balanced fluid administration approach.

Conclusions:

  • A simplified fluid metric of 500 mL/h in ERAS pathways is effective in improving postoperative kidney function.
  • This metric balances hydration, reducing overhydration risks and facilitating adherence to fluid guidelines.
  • The proposed metric offers a practical, evidence-based approach for fluid administration in various healthcare settings for patients undergoing ERAS procedures.