Post-operative outcomes of intra-operative restrictive and conventional fluid management in laparoscopic colorectal cancer surgery

Abstract

Context: Intra-operative fluid management has been shown to significantly alter a patient's clinical condition in peri-operative care. Studies in the literature that investigated the effects of different amounts of intra-operative fluids on outcomes reported conflicting results. Aims: To compare the post-operative results of intra-operative restrictive and conventional fluid administrations in laparoscopic colorectal cancer surgery. Settings and Design: All patients with ASA I, II and III, and those who had undergone laparoscopic colorectal cancer surgery were included. It was a retrospective, cohort study. Subjects and Methods: A review of laparoscopic colorectal cancer surgeries performed by the same fellow-trained colorectal surgeon with different anaesthesiologists between 1 January, 2018 and 30 November, 2021. Results: In total 80 patients were analysed; 2 patients were excluded, 28 patients were in restrictive (Group R) and 50 patients were in the conventional (Group C) group. The median age of all patients was 63 years and 74% were male. The median (interquartile ranges 25 to 75) intra-operative fluid administration was significantly different between groups; 3 ml/kg/h in Group R, and 7.2 ml/kg/h in Group C. (P < 0.001) Patients in Group C had significantly high post-operative intensive care unit admission (P < 0.05), and hospital length of stay (P = 0.005) compared to Group R. Conclusions: Intra-operative fluid management was significantly associated with post-operative hospital length of stay and intensive care unit admission. Excessive intra-operative fluid management should be avoided in daily practice to improve the outcomes of laparoscopic colorectal cancer surgery.

Keywords

• colorectal surgery
• critical care
• fluid therapy
• length of stay
• perioperative care