Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India
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...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/18541/63327_CE[Ra1]_F(KM)_QC(AN_RDW_IS)_PF1(AG_KM)_PFA(AG_KM)_PN(KM).pdf |
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| author | GINCY ANN LUKACHAN Anita Mathew Deepak Varughese Ashu Sara Mathai |
| author_facet | GINCY ANN LUKACHAN Anita Mathew Deepak Varughese Ashu Sara Mathai |
| author_sort | GINCY ANN LUKACHAN |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T16:38:08Z |
| format | Article |
| id | doaj.art-70cd07cdf6ed48d09f4b013fe183e0c7 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-11T16:38:08Z |
| publishDate | 2023-10-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-70cd07cdf6ed48d09f4b013fe183e0c72023-10-23T11:00:25ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-10-011710172110.7860/JCDR/2023/63327.18541Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern IndiaGINCY ANN LUKACHAN0Anita Mathew1Deepak Varughese2Ashu Sara Mathai3Associate Professor, Department of Anaesthesiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.Professor, Department of Anaesthesiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.Assistant Professor, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.Professor, Department of Anaesthesiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.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.https://www.jcdr.net/articles/PDF/18541/63327_CE[Ra1]_F(KM)_QC(AN_RDW_IS)_PF1(AG_KM)_PFA(AG_KM)_PN(KM).pdfcrystalloidfluid therapyileuspostoperative complicationssurgical site infection |
| spellingShingle | GINCY ANN LUKACHAN Anita Mathew Deepak Varughese Ashu Sara Mathai Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India Journal of Clinical and Diagnostic Research crystalloid fluid therapy ileus postoperative complications surgical site infection |
| title | Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India |
| title_full | Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India |
| title_fullStr | Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India |
| title_full_unstemmed | Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India |
| title_short | Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India |
| title_sort | practice of intraoperative fluid administration during major abdominal surgeries a retrospective cohort study at a tertiary care hospital in southern india |
| topic | crystalloid fluid therapy ileus postoperative complications surgical site infection |
| url | https://www.jcdr.net/articles/PDF/18541/63327_CE[Ra1]_F(KM)_QC(AN_RDW_IS)_PF1(AG_KM)_PFA(AG_KM)_PN(KM).pdf |
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