Liberal versus restrictive perioperative fluid regimen and postoperative outcome ( a literature review 2002-2020)
Background: Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear.
Objective: To assess the Liberal Versus Restrictive Perioperative Fluid Regimen and Postoperative Outcome in Previous studies, 2002-2020.
Methods: Use a Descriptive random design approach because of the types of variables to be measured. A PubMed search identified randomized clinical trials comparing the effect of two different fixed fluid volumes on one or more post-operative clinical outcome parameters in adults undergoing major surgery. Search terms ‘fluid therapy’ and ‘outcome’ were combined and limited to randomized human studies published in English and with patients >18 years in the period 2002–2020. And used meta-analysis for analysis the results of studies.
Results: Two studies, Lobo¹⁷ 2002 (Himecolectomy) study and Nisanevich²¹ 2005 (Major abdominal surgery) study showed that Restrictive: increase GI recovery and decrease complications, LOS. Five studies, Brandstrup¹⁸ 2003 study (Colorectal resection), Fajardo²³ 2009 study (Abdominal Vascular Surgery), Piljic²⁶ 2013 study (Minilaparotomy abdominal aortic repair), Geralde²⁴ 2009 study(Open abdominal aortic aneurysm Repair) and STEPHEN²⁵ 2010 study (Colorectal surgery), showed that Restrictive: decease Hospital stay, and Complication. Study of Messina²⁷ 2019 (Major abdominal surgery), showed that Restrictive: no change affect overall major postoperative complications or mortality. Andrino²⁸ 2020 study (Cesarean) showed that Restrictive: increase postoperative AKI. Study of Holte¹⁹ 2004 (Laparoscopic Cholecystectomy), showed that Liberal: increase postoperative organ functions and recovery. decrease hospital stay. Kabon²⁰ 2005 (Colon resection), showed that the liberal and restrictive: no change in Wound infection. Mackay²² 2006 (Colorectal resection), showed that the libral and restrictive: no change in GI recovery, LOS (7.2 days), complications. Holte⁵ 2007 (Arthroplasty), showed that Liberal: decrease vomiting. increase coagulation, and pulmonary function. no change in exercise capacity, pain, nausea, appetite, well-being, fatigue, ileus, post-op hypoxaemia, LOS. Another study by Holte⁸ 2007 (Colonic surgery), showed that Liberal: decrease pulmonary function, vasoactive hormones, total complications. no change in exercise capacity, ileus, pain, well-being, thirst, headache, dizzy/drowsiness, fatigue, LOS. Forbes¹ 2018 (Major Abdominal Surgery), showed that Liberal: decrease Complication.
Conclusions: Inconsistent outcome results and study designs have been reported with the use of a liberal vs. a restrictive fluid regimen. These inconsistencies relate both to the amount of administered fluid volume in the liberal vs. restrictive fluid regimens, indications for additional fluid, and to the defined intra- and post-operative period as well as information on perioperative care principles hindering direct comparison and interpretation. Accordingly, it is recommended to abandon the terms liberal and restrictive when referring to the size of a fixed volume fluid regimen. Therefore, evidence-based guidelines for optimal procedure-specific perioperative fixed-volume regimens cannot be formulated.
Objective: To assess the Liberal Versus Restrictive Perioperative Fluid Regimen and Postoperative Outcome in Previous studies, 2002-2020.
Methods: Use a Descriptive random design approach because of the types of variables to be measured. A PubMed search identified randomized clinical trials comparing the effect of two different fixed fluid volumes on one or more post-operative clinical outcome parameters in adults undergoing major surgery. Search terms ‘fluid therapy’ and ‘outcome’ were combined and limited to randomized human studies published in English and with patients >18 years in the period 2002–2020. And used meta-analysis for analysis the results of studies.
Results: Two studies, Lobo¹⁷ 2002 (Himecolectomy) study and Nisanevich²¹ 2005 (Major abdominal surgery) study showed that Restrictive: increase GI recovery and decrease complications, LOS. Five studies, Brandstrup¹⁸ 2003 study (Colorectal resection), Fajardo²³ 2009 study (Abdominal Vascular Surgery), Piljic²⁶ 2013 study (Minilaparotomy abdominal aortic repair), Geralde²⁴ 2009 study(Open abdominal aortic aneurysm Repair) and STEPHEN²⁵ 2010 study (Colorectal surgery), showed that Restrictive: decease Hospital stay, and Complication. Study of Messina²⁷ 2019 (Major abdominal surgery), showed that Restrictive: no change affect overall major postoperative complications or mortality. Andrino²⁸ 2020 study (Cesarean) showed that Restrictive: increase postoperative AKI. Study of Holte¹⁹ 2004 (Laparoscopic Cholecystectomy), showed that Liberal: increase postoperative organ functions and recovery. decrease hospital stay. Kabon²⁰ 2005 (Colon resection), showed that the liberal and restrictive: no change in Wound infection. Mackay²² 2006 (Colorectal resection), showed that the libral and restrictive: no change in GI recovery, LOS (7.2 days), complications. Holte⁵ 2007 (Arthroplasty), showed that Liberal: decrease vomiting. increase coagulation, and pulmonary function. no change in exercise capacity, pain, nausea, appetite, well-being, fatigue, ileus, post-op hypoxaemia, LOS. Another study by Holte⁸ 2007 (Colonic surgery), showed that Liberal: decrease pulmonary function, vasoactive hormones, total complications. no change in exercise capacity, ileus, pain, well-being, thirst, headache, dizzy/drowsiness, fatigue, LOS. Forbes¹ 2018 (Major Abdominal Surgery), showed that Liberal: decrease Complication.
Conclusions: Inconsistent outcome results and study designs have been reported with the use of a liberal vs. a restrictive fluid regimen. These inconsistencies relate both to the amount of administered fluid volume in the liberal vs. restrictive fluid regimens, indications for additional fluid, and to the defined intra- and post-operative period as well as information on perioperative care principles hindering direct comparison and interpretation. Accordingly, it is recommended to abandon the terms liberal and restrictive when referring to the size of a fixed volume fluid regimen. Therefore, evidence-based guidelines for optimal procedure-specific perioperative fixed-volume regimens cannot be formulated.