Restricting Fluids Post Abdominal Surgery Doesn't Up Survival
Fluid restriction has no impact on disability-free survival; increases risk of acute kidney injury
(HealthDay News) -- A restrictive fluid regimen is not associated with increased disability-free survival for patients at increased risk of complications during major abdominal surgery, but is associated with increased acute kidney injury, according to a study published online in the New England Journal of Medicine. The research was published to coincide with the annual meeting of the Australian and New Zealand College of Anaesthetists, held from May 7 to 11 in Sydney.
Paul S. Myles, MPH, DSc, from Monash University in Melbourne, Australia, and colleagues randomized 3000 patients who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen during and up to 24 hours after surgery (1490 and 1493 patients, respectively).
The researchers found that at one-year, the rate of disability-free survival was 81.9 and 82.3% in the restrictive and liberal fluid groups, respectively (hazard ratio for death or disability, 1.05; 95% confidence interval, 0.88 to 1.24; P=0.61). The rate of acute kidney injury was 8.6 and 5.0% in the restrictive and liberal fluid groups, respectively (P<0.001).
"Among patients at increased risk for complications during major abdominal surgery, a restrictive fluid regimen was not associated with a higher rate of disability-free survival than a liberal fluid regimen and was associated with a higher rate of acute kidney injury," the authors write.
Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. New Engl J Med. DOI: 10.1056/NEJMoa1801601 [Published online May 10, 2018]
Brandstrup B. Finding the Right Balance. New Engl J Med.DOI: 10.1056/NEJMe1805615 [Published online May 10, 2018]