Patterns and Clinical Outcomes Associated with Routine Intravenous Sodium and Fluid Administration after Colorectal Resection

Abstract

Excess intravenous water and sodium may be associated with postoperative complications and an adverse outcome. However, the effect of the magnitude of the surgery on such a relation has not been studied. This study assesses current practice in intravenous fluid and sodium administration after colonic and rectal resection and its relation to the postoperative outcome. A series of 100 consecutive patients undergoing elective colonic (n = 44) or rectal resection (n = 56) were included in a retrospective case-cohort study. The volumes of water and sodium from intravenous fluid and antibiotic administration on the day of surgery and the next 5 days were recorded together with the clinical outcome. The mean +/- SEM fluid and sodium administration on the day of operation was greater after rectal than colonic resection (4.6 +/- 0.2 vs. 3.6 +/- 0.2 liters and 507 +/- 34 vs. 389 +/- 22 mmol, respectively (p < 0.05). The mean +/- SEM rate of daily fluid and sodium administration for the 5 subsequent days was greater following rectal than colonic resection (2.1 +/- 0.1 vs. 1.8 +/- 0.1 L/day and 155 +/- 8.7 vs. 128 +/- 8.0 mmol/day; p < 0.05). For all resections, there were no differences in fluid and sodium administration on the day of surgery in patients with or without postoperative complications. During the subsequent 5 days, patients with complications after colonic resection had a higher postoperative mean rate of intravenous sodium administration than those who did not (149 +/- 12 vs. 115 +/- 10 mmol; p < 0.05). A similar pattern was not observed following rectal resection. Current postoperative intravenous fluid prescription delivers approximately 2 liters of fluid and 140 mmol of sodium per day. Complications after colonic, but not rectal, resection are associated with more early postoperative daily intravenous sodium administration. Because colonic resection poses less of a physiologic insult than rectal resection, the overall outcome in the former group may be more sensitive to the interplay between fluid and sodium overload and patient co-morbidity.

Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients

“…Regimens of restrict use of fluids are associated with less postoperative complications and shorten postoperative stay (7) . Generous intravenous fluids therapy increases body weight and may cause edema, pulmonary complications, and prolonged ileus (7,16,21,30) . A significant fall of intravenous fluid prescription at postoperative period was achieved after the ACERTO protocol was initiated.…”

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…This frequently exceeds actual fluid losses, resulting in a weight gain of 3-6 kg [145,146]. Excessive overload of salt and water in the perioperative period increases postoperative complication rates and delays the return of gastrointestinal function [146][147][148][149].…”

Preoperative Preparation in Colorectal Surgery

“…Postoperative weight gains after intra-operative fluid overload have been associated with poor survival and complication. 27,136,137 The pattern peri-operative intravenous fluid administration has a major effect upon cardio-respiratory and anastomotic complications, and restricted peri-operative intravenous fluid management and a preoperative carbohydrate drink were found to be of specific importance for beneficial outcomes. 32 Factors that allow successful use of restricted intra-operative fluid regimen include preventing the patient from coming to the theatre in a dehydrated state by avoiding bowel preparation or excessive duration of preoperative fasting.…”