Assessment of Intraoperative Fluid Administration Practices in Various Surgical Specialties: a Population Based Study

Abstract

Objective

The main objective of the study is to assess the variation in different hospitals towards the intraoperative fluid management and their association during postoperative complications.

Background: Intraoperative fluid management (IOFM)

A substantial body of evidence is existing to support the use of intraoperative fluid management, which has resulted in the process forming one of the core components of Enhanced Recovery Programs. IOFM using a SV optimization (SVO) Algorithm is best method. Studies using the esophageal Doppler (ODM) for IOFM demonstrated a reduction in the incidence of postoperative complications (OR: 0.882; P<0.001). The Lacunae is due to the lack of institution-level studies of resuscitation practices and increasing interest in goal-directed, restricted-volume fluid administration for major surgery.

Methods

We have developed a computed intraoperative fluid balance accounting for patient morphometric, crystalloid, colloid, blood products, urine, blood loss, duration, compared patterns across disciplines and their associations with risk-adjusted postoperative length of stay (pLOS), and approach.Among 50 hospitals in the entire selected state-wide surgical collaborative, we profiled fluid administration practices during 6043 intestinal resections, 18,123 hysterectomies, and 951 abdominopelvic endovascular procedures.

Results

In our study we find that there is a  lot of variation in fluid balance between hospitals (P < 0.001, all procedures), but significant within-hospital correlation across operations.

• Highest fluid balance hospitals had significantly longer adjusted pLOS than lowest balance hospitals for intestinal resection (5.4 vs 4.4 d, P < 0.001) and


• Hysterectomy (1.6 vs 1.3 d, P < 0.001), but not endovascular (1.8 vs 2.0 d, P = 0.78). Risk-adjusted complication rates were not associated with fluid balance rankings.

Conclusion

• The highest fluid balance hospitals have 11% to 13% longer risk-adjusted pLOS for visceral abdominal surgery


• Independent of patient complexity and complications. The findings were consistent with evidence that isovolemic resuscitation in enhanced recovery protocols accelerates recovery of bowel function.


• intraoperative fluid administration practice patterns are pervasive across disparate procedures