Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysis
Abstract Background Diligent fluid management is an instrumental part of Enhanced Recovery After Surgery. However, the effect of a ward regimen to limit intravenous fluid administration on outcome remains unclear. We performed a meta-analysis investigating the effect of a restrictive versus a conven...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Perioperative Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13741-023-00337-9 |
| _version_ | 1797557634196307968 |
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| author | Joachim J. Bosboom Marije Wijnberge Bart F. Geerts Martijn Kerstens Michael G. Mythen Alexander P. J. Vlaar Markus W. Hollmann Denise P. Veelo |
| author_facet | Joachim J. Bosboom Marije Wijnberge Bart F. Geerts Martijn Kerstens Michael G. Mythen Alexander P. J. Vlaar Markus W. Hollmann Denise P. Veelo |
| author_sort | Joachim J. Bosboom |
| collection | DOAJ |
| description | Abstract Background Diligent fluid management is an instrumental part of Enhanced Recovery After Surgery. However, the effect of a ward regimen to limit intravenous fluid administration on outcome remains unclear. We performed a meta-analysis investigating the effect of a restrictive versus a conventional fluid regimen on complications in patients after non-cardiac surgery in the postoperative period on the clinical ward. Study design We performed a systematic search in MEDLINE, Embase, Cochrane Library, and CINAHL databases, from the start of indexing until June 2022, with constraints for English language and adult human study participants. Data were combined using classic methods of meta-analyses and were expressed as weighted pooled risk ratio (RR) or odds ratio (OR) with 95% confidence interval (CI). Quality assessment and risk of bias analyses was performed according to PRISMA guidelines. Results Seven records, three randomized controlled trials, and four non-randomized studies were included with a total of 883 patients. A restrictive fluid regimen was associated with a reduction in overall complication rate in the RCTs (RR 0.46, 95% CI 0.23 to 0.95; P < .03; I 2 = 35%). This reduction in overall complication rate was not consistent in the non-randomized studies (RR 0.74, 95% CI 0.53 to 1.03; P 0.07; I 2 = 45%). No significant association was found for mortality using a restrictive fluid regimen (RCTs OR 0.51, 95% CI 0.05 to 4.90; P = 0.56; I 2 = 0%, non-randomized studies OR 0.30, 95% CI 0.06 to 1.46; P = 0.14; I 2 = 0%). A restrictive fluid regimen is significantly associated with a reduction in postoperative length of stay in the non-randomized studies (MD − 1.81 days, 95% CI − 3.27 to − 0.35; P = 0.01; I 2 = 0%) but not in the RCTs (MD 0.60 days, 95% CI − 0.75 to 1.95; P = 0.38). Risk of bias was moderate to high. Methodological quality was very low to moderate. Conclusion This meta-analysis suggests restrictive fluid therapy on the ward may be associated with an effect on postoperative complication rate. However, the quality of evidence was moderate to low, the sample size was small, and the data came from both RCTs and non-randomized studies. |
| first_indexed | 2024-03-10T17:19:23Z |
| format | Article |
| id | doaj.art-85f7ebf592ed4d57aa0e3b4cf60adb71 |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-03-10T17:19:23Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-85f7ebf592ed4d57aa0e3b4cf60adb712023-11-20T10:23:27ZengBMCPerioperative Medicine2047-05252023-09-011211910.1186/s13741-023-00337-9Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysisJoachim J. Bosboom0Marije Wijnberge1Bart F. Geerts2Martijn Kerstens3Michael G. Mythen4Alexander P. J. Vlaar5Markus W. Hollmann6Denise P. Veelo7Department of Anesthesiology, Amsterdam UMC, Amsterdam UniversityDepartment of Anesthesiology, Amsterdam UMC, Amsterdam UniversityHealthplus.Ai-R&D B.V.Department of Anesthesiology, Amsterdam UMC, Amsterdam UniversityDepartments of Anesthesia and Critical Care, University College London Hospitals, National Institute of Health Research Biomedical Research CentreDepartment of Intensive Care Medicine, Amsterdam UMC, Amsterdam UniversityDepartment of Anesthesiology, Amsterdam UMC, Amsterdam UniversityDepartment of Anesthesiology, Amsterdam UMC, Amsterdam UniversityAbstract Background Diligent fluid management is an instrumental part of Enhanced Recovery After Surgery. However, the effect of a ward regimen to limit intravenous fluid administration on outcome remains unclear. We performed a meta-analysis investigating the effect of a restrictive versus a conventional fluid regimen on complications in patients after non-cardiac surgery in the postoperative period on the clinical ward. Study design We performed a systematic search in MEDLINE, Embase, Cochrane Library, and CINAHL databases, from the start of indexing until June 2022, with constraints for English language and adult human study participants. Data were combined using classic methods of meta-analyses and were expressed as weighted pooled risk ratio (RR) or odds ratio (OR) with 95% confidence interval (CI). Quality assessment and risk of bias analyses was performed according to PRISMA guidelines. Results Seven records, three randomized controlled trials, and four non-randomized studies were included with a total of 883 patients. A restrictive fluid regimen was associated with a reduction in overall complication rate in the RCTs (RR 0.46, 95% CI 0.23 to 0.95; P < .03; I 2 = 35%). This reduction in overall complication rate was not consistent in the non-randomized studies (RR 0.74, 95% CI 0.53 to 1.03; P 0.07; I 2 = 45%). No significant association was found for mortality using a restrictive fluid regimen (RCTs OR 0.51, 95% CI 0.05 to 4.90; P = 0.56; I 2 = 0%, non-randomized studies OR 0.30, 95% CI 0.06 to 1.46; P = 0.14; I 2 = 0%). A restrictive fluid regimen is significantly associated with a reduction in postoperative length of stay in the non-randomized studies (MD − 1.81 days, 95% CI − 3.27 to − 0.35; P = 0.01; I 2 = 0%) but not in the RCTs (MD 0.60 days, 95% CI − 0.75 to 1.95; P = 0.38). Risk of bias was moderate to high. Methodological quality was very low to moderate. Conclusion This meta-analysis suggests restrictive fluid therapy on the ward may be associated with an effect on postoperative complication rate. However, the quality of evidence was moderate to low, the sample size was small, and the data came from both RCTs and non-randomized studies.https://doi.org/10.1186/s13741-023-00337-9Fluid therapyPostoperative periodInfusionsIntravenous |
| spellingShingle | Joachim J. Bosboom Marije Wijnberge Bart F. Geerts Martijn Kerstens Michael G. Mythen Alexander P. J. Vlaar Markus W. Hollmann Denise P. Veelo Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysis Perioperative Medicine Fluid therapy Postoperative period Infusions Intravenous |
| title | Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysis |
| title_full | Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysis |
| title_fullStr | Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysis |
| title_full_unstemmed | Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysis |
| title_short | Restrictive versus conventional ward fluid therapy in non-cardiac surgery patients and the effect on postoperative complications: a meta-analysis |
| title_sort | restrictive versus conventional ward fluid therapy in non cardiac surgery patients and the effect on postoperative complications a meta analysis |
| topic | Fluid therapy Postoperative period Infusions Intravenous |
| url | https://doi.org/10.1186/s13741-023-00337-9 |
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