Introduction: Intraoperative fluid management is a subject of contention within the field of anesthesiology. If inappropriate, it can lead to increased morbidity and/or mortality. There are numerous proposed fluid management models in the literature1, as well as provider preference influencing intraoperative fluids management.
To better elucidate the effect of intraoperative fluids, this study examined the association between intraoperative fluids with post-operative complications at LAC+USC medical center.
Methods: A retrospective chart review of 599 patients over 18 years of age who had elective non-cardiac surgery during January 1, 2011-March 15, 2016 at LAC+USC medical center was completed. Of those 599 patients, 300 had intra-abdominal surgeries and 299 had extra-abdominal surgeries. The following variables were recorded for each patient within each group: anesthesia type, type of fluids, anesthesia duration, amount of fluids infused, estimated blood loss, urine output, intraoperative vasopressor/inotrope Use, preoperative Hb/Hct and Albumin, pre/intra/postoperative vital signs, mortality. Stepwise logistic regression with backward elimination was performed to investigate the associations between these variables and postoperative complications.
Results: We found that intra-abdominal surgeries were 2.472 times more likely to experience postoperative complications than extra-abdominal surgeries (p<0.001). Also, patients who were infused with >2 liters of fluids were 1.003 times more likely to experience postoperative complications than those receiving <=2 liters (p=0.005) independent of surgery type (intra-abdominal vs extra-abdominal). The most common complication in both intra-abdominal and extra-abdominal surgery were post-operative nausea and vomiting.
Conclusion: The data demonstrates patients receiving greater than 2 liters of intraoperative fluids have a greater likelihood of experiencing postoperative complications after adjusting for intra- or extra-abdominal surgery.
References: 1M. Doherty, D. J. Buggy; Intraoperative fluids: how much is too much?. Br J Anaesth 2012; 109 (1): 69-79. doi: 10.1093/bja/aes171
