The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

Abstract

Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology: We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Among the 472 articles selected from the databases, based on abstract reading, 272 articles were excluded according to the criteria in Figure 1. After reading the complete text, among the 78 remaining articles, excluded were 15 articles with no relevant data about the outcome of restrictive fluid therapy for major abdominal surgery, 54 that were not RCTs, 2 that were meta-analyses, and 7 that were from the same trial. Finally, 11 RCTs published between 2000 and 2018 that compared restrictive fluid therapy with liberal fluid therapy were included. Two studies by the same team were taken as one trial and shared the same study number because some data from the two studies were complementary.. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: the current meta-analysis assessed the effects of restrictive fluid therapy in a meticulous way. Though the large proportional reduction in risk of complications as indicated in the previous literature was not confirmed, moderate but clinically notable reduction in complications is still worth our attention. The application of restrictive fluid therapy requires communication and cooperation between medical workers and patients. RCTs on restrictive fluid therapy with long-term follow-up are needed. Hospital costs and quality of life after surgery should also be taken into account. Furthermore, the benefits of restrictive fluid therapy in elderly patients and patients who have undergone other surgeries might be the focus of future research..