Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India

Abstract

Introduction: Optimal intraoperative fluid therapy can reduce postoperative complications and improve patient outcomes. The Enhanced Recovery After Surgery (ERAS) protocols emphasise fluid restriction. However, the recent randomised clinical trial (RELIEF trial) found a higher incidence of Acute Kidney Injury (AKI) with restrictive fluid therapy. Both excessive and restricted fluid therapy have adverse consequences. Despite various guidelines on perioperative fluid therapy, there is still wide variation in practise. Aim: To describe the volumes and types of intravenous fluids used during major abdominal surgeries and evaluate the association of intraoperative fluid administration with postoperative complications. Materials and Methods: This retrospective cohort study was conducted in a multispecialty tertiary care hospital in Thiruvalla, Kerala, India. The study collected data on volumes and types of fluid used in adults undergoing major abdominal surgeries over a one-year period. The incidence of postoperative complications, specifically Postoperative Ileus (POI), Surgical Site Infections (SSI), cardiac complications, and respiratory complications, was noted. The factors affecting intraoperative fluid intake were assessed using the Wilcoxon signed-rank test. Logistic regression was performed to determine associations between preoperative and intraoperative variables and postoperative complications. Adjusted Odds Ratios (OR) and Confidence Intervals (CI) were calculated. Results: The study included 133 patients with complete data. The mean age of the cohort was 62±18 years, and 69 (52%) patients were males. Patients received a median (IQR) total intraoperative fluid of 3000 (2000-4000) mL with a median infusion rate of 8.77 (6.39-12.35) mL/kg/hr. The majority (132 patients, 99%) received balanced salt solution (ringer lactate) as the main crystalloid. The volume of intravenous fluids infused intraoperatively was significantly greater in emergency surgeries (p-value=0.007), open surgical approaches (p-value <0.001), and surgeries under regional anaesthesia (p-value=0.012). The most common complication in this cohort was POI (38%), which had a significant association with the duration of the surgery (p-value=0.002). Cardiac complications were linked to the volume of intraoperative fluid intake (p-value=0.022), while respiratory complications were predominantly linked to upper abdominal surgeries (p-value=0.049). Conclusion: The volume of intraoperative fluids administered in major abdominal surgeries varies with the type of surgery (elective versus emergency, open versus laparoscopic) and anaesthesia (regional/general) and significantly impacts patient outcomes after surgery.

Keywords

• crystalloid
• fluid therapy
• ileus
• postoperative complications
• surgical site infection