Restrictive versus liberal fluid strategy does not affect complications after abdominal surgery: Study

Italy: Perioperative fluid management with a liberal or restrictive approach did not affect overall major postoperative mortality or complications in patients undergoing major abdominal elective surgery, finds a recent study. The findings of the study were published in the journal Critical Care.

A subgroup analysis showed a liberal approach to be associated with lower overall complication renal major events as compared to the restrictive perioperative fluid policy. 

Postoperative complications can impact a patient's long-term morbidity, health, and financial systems. Considering this, there has been worldwide efforts to reduce them. Many perioperative strategies have been proposed to optimize intraoperative management and postoperative care. Among them, appropriate perioperative fluid management is pivotal, However, there is a lack of clarity in the most effective perioperative fluid management. 

The enhanced recovery after surgery pathways recommends a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial.

Against the above background, Antonio Messina, Humanitas University, Pieve Emanuele, MI, Italy, and colleagues aimed to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality.

For this purpose, the researchers performed a systematic review and meta-analysis, including randomized controlled trials (RCTs). A systematic literature search was performed using online databases. They included RCTs that enrolled adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup.

After full-text examination, the researchers finally included 18 studies and 5567 patients randomized to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). 

"In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality," wrote the authors. "In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive."

"The lack of consistency in perioperative overall fluid balance and in the definitions of clinical outcomes still affects the comparability of the results of RTCs, soliciting clear standards in data reporting," they concluded. 

Reference:

The study titled, "Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery," is published in the journal Critical Care.

DOI: https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03629-y