Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 26;13(1):32.
doi: 10.1186/s13741-024-00390-y.

The association of the perioperative fluid balance and cardiopulmonary complications in emergency gastrointestinal surgery: exploration of a randomized trial

Anders W Voldby  1 , Anne A Aaen  2 , Ann M Møller  3   4 , Birgitte Brandstrup  5   6
Affiliations

The association of the perioperative fluid balance and cardiopulmonary complications in emergency gastrointestinal surgery: exploration of a randomized trial

Anders W Voldby et al. Perioper Med (Lond). .

Abstract

Background: The association between perioperative fluid administration and risk of complications following emergency surgery is poorly studied. We tested the association between the perioperative fluid balance and postoperative complications following emergency surgery for gastrointestinal obstruction or perforation.

Methods: We performed a re-assessment of data from the Goal-directed Fluid Therapy in Urgent Gastrointestinal Surgery Trial (GAS-ART) studying intra-operative stroke volume optimization and postoperative zero-balance fluid therapy versus standard fluid therapy. The cohort was divided into three groups at a perioperative fluid balance (FB) of low < 0 L, moderate 0-2 L, or high > 2 L. We used a propensity adjusted logistic regression to analyse the association with cardiopulmonary (primary outcome), renal, infectious, and wound healing complications. Further, the risk of complications was explored on a continuous scale of the FB.

Results: We included 303 patients: 44 patients belonged to the low-FB group, 108 to the moderate-FB group, and 151 to the high-FB group. The median [interquartile range] perioperative FB was -0.9 L [-1.4, -0.6], 0.9 L [0.5, 1.3], and 3.8 L [2.7, 5.3]. The risk of cardiopulmonary complications was significantly higher in the High-FB group 3.4 (1.5-7.6), p = 0.002 (odds ratio (95% confidence interval). On a continuous scale of the fluid balance, the risk of cardiopulmonary complications was minimal at -1 L to 1 L.

Conclusion: Following emergency surgery for gastrointestinal obstruction or perforation, a fluid balance < 2.0 L was associated with decreased risk of cardiopulmonary complications without increasing renal complications.

Keywords: Fluid therapy; Intestinal obstruction; Intestinal perforation; Intraoperative care; Postoperative complications; Prospective study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The predicted risk of a cardiopulmonary complication associated with the perioperative fluid balance. The blue line shows the predicted risk of a complication. The shaded area is the 95% confidence interval. We used a generalized additive model with smoothing splines and four degrees of freedom. The parametric effect is p < 0.001, and the non-parametric effect is p = 0.008. The parametric calculation tests whether the fluid balance is linear associated with complications. The non-parametric analysis tests whether smoothing splines adds further precision to a linear relation of the model
Fig. 2
Fig. 2
The predicted risk of a renal complication associated with the perioperative fluid balance. The blue line shows the predicted risk of a complication. The shaded area is the 95% confidence interval. We used a generalized additive model with smoothing splines and four degrees of freedom. The parametric effect is p = 0.004, and the non-parametric effect is p = 0.334. The parametric calculation tests whether the fluid balance is linear associated with complications. The non-parametric analysis tests whether smoothing splines adds further precision to a linear relation of the model
See this image and copyright information in PMC

References

    1. Aaen AA, Voldby AW, Storm N, et al. Goal-directed fluid therapy in emergency abdominal surgery: a randomised multicentre trial. Br J Anaesth. 2021;127(4):521–531. doi: 10.1016/j.bja.2021.06.031. - DOI - PubMed
    1. Abraham-Nordling M, Hjern F, Pollack J, Prytz M, Borg T, Kressner U. Randomized clinical trial of fluid restriction in colorectal surgery. Br J Surg. 2012;99(2):186–191. doi: 10.1002/bjs.7702. - DOI - PubMed
    1. Becher RD, Hoth JJ, Miller PR, Mowery NT, Chang MC, Meredith JW. A critical assessment of outcomes in emergency versus nonemergency general surgery using the American College of Surgeons National Surgical Quality Improvement Program database. Am Surg. 2011;77(7):951–959. doi: 10.1177/000313481107700738. - DOI - PubMed
    1. Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238(5):641–648. doi: 10.1097/01.sla.0000094387.50865.23. - DOI - PMC - PubMed
    1. Futier E, Constantin J-M, Petit A, et al. Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial. Arch Surg. 2010;145(12):1193–1200. doi: 10.1001/archsurg.2010.275. - DOI - PubMed

LinkOut - more resources