The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study

Abstract

IntroductionIn some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate.MethodsWe conducted a prospective cohort study during one year in four ICUs from three tertiary hospitals, which included patients aged 18 years or more who required postoperative ICU after undergoing major surgery. Patients who underwent palliative surgery and whose fluid balance could change in outcome were excluded. The calculation of fluid balance was based on preoperative fasting, insensible losses from surgeries and urine output minus fluid replacement intraoperatively.ResultsThe study included 479 patients. Mean age was 61.2 ± 17.0 years and 8.8% of patients died at the hospital during the study. The median duration of surgery was 4.0 (3.2 to 5.5) h and the value of the Simplified Acute Physiology Score (SAPS) 3 score was 41.8 ± 14.5. Comparing survivors and non-survivors, the intraoperative fluid balance from non-survivors was higher (1,950 (1,400 to 3,400) mL vs. 1,400 (1,000 to 1,600) mL, P <0.001). Patients with fluid balance above 2,000 mL intraoperatively had a longer ICU stay (4.0 (3.0 to 8.0) vs. 3.0 (2.0 to 6.0), P <0.001) and higher incidence of infectious (41.9% vs. 25.9%, P = 0.001), neurological (46.2% vs. 13.2%, P <0.001), cardiovascular (63.2% vs. 39.6%, P <0.001) and respiratory complications (34.3% vs. 11.6%, P <0.001). In multivariate analysis, the fluid balance was an independent factor for death (OR per 100 mL = 1.024; P = 0.006; 95% CI 1.007 to 1.041).ConclusionsPatients with excessive intraoperative fluid balance have more ICU complications and higher hospital mortality.

The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia

“…8,9,13,14 Excessive perioperative fluid loading leads to extravascular fluid accumulation and weight gain, which corresponds with increased mortality and morbidity during the early postoperative period. 6,8,15 Several meta-analyses have reported that goaloriented fluid therapy significantly reduces renal and pulmonary postoperative complications, and accelerates the first bowel movement, the resumption of normal diet, and shortens the length of stay in hospital. Restrictive fluid administration reduces postoperative pneumonia and pulmonary edema.…”

“…Restrictive fluid administration reduces postoperative pneumonia and pulmonary edema. 6,15,16 An inappropriate fluid administration disturbs the liberation of atrial natriuretic peptide, and injures the endothelial glycocalix, leading to the damage of the vascular barrier and increased fluid shifts into the extravascular space. 7,17 This pathology may result in abnormal extravascular water content, tissue edema, and raised IAP.…”

“…3,4 Several studies have documented significant benefits resulting from BIA-controlled fluid balance. 3,5,6 Unfortunately, only 1 study has analysed the effect of perioperative fluid therapy on body water distribution in patients undergoing various elective gynecological procedures under general anesthesia. 6 In addition, the effect of crystalloid therapy has not been documented in conscious spinal-anesthetized patients.…”

Angka Mortalitas pasien Neonatus yang Menjalani Operasi berdasar atas Kenaikan Berat Badan Pascaoperasi yang Dirawat di Neonatal Intensive Care Unit (NICU)

“…2,17 Angka mortalitas pada usia gestasi kurang dari 37 minggu berdasar atas kenaikan berat badan pascaoperasi didapatkan 32 pasien dengan angka mortalitas 78% (Tabel 3). Pasien neonatus yang lahir disebut prematur jika usia gestasi kurang dari 37 minggu, bayi prematur memiliki angka mortalitas pascaoperasi yang lebih tinggi dibanding dengan bayi lahir cukup bulan.…”

Impact of perioperative hyponatremia in children: A narrative review

“…Inadequate fluid management may cause reduced cardiac output and oxygen delivery to damaged tissue, which is associated with an increased rate of postoperative complications [1] . On the other hand, overhydration can have equally severe consequences, such as acidosis, coagulation deficits and periph-eral and pulmonary edema [2][3][4][5] . Children undergoing surgery are at a higher risk for developing hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell.…”