• Mohamed A Abd El Aziz, Fabian Grass, Giacomo Calini, Jenna K Lovely, Adam K Jacob, Kevin T Behm, D'AngeloAnne-Lise DADColon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, MN., Sherief F Shawki, Kellie L Mathis, and David W Larson.
• Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
• Ann. Surg. 2022 May 1; 275 (5): 891-896.

ObjectiveWe aimed to determine a safe zone of intraoperative fluid management associated with the lowest postoperative complication rates without increased acute kidney injury (AKi) risk for elective colorectal surgery patients.BackgroundTo date, standard practice within institutions, let alone national expectations related to fluid administration, are limited. This fact has perpetuated a quality gap.MethodsElective colorectal surgeries between 2018 and 2020 were included. Unadjusted odds ratios (ORs) for postoperative ileus, prolonged LOS, and AKi were plotted against the rate of intraoperative RL infusion (mL/ kg/h) and total intraoperative volume. Binary logistic regression analysis, including fluid volumes as a confounder, was used to identify risk factors for postoperative complications.ResultsA total of 2900 patients were identified. Of them, 503 (17.3%) patients had ileus, 772 (26.6%) patients had prolonged LOS, and 240 (8.3%) patients had AKI. The intraoperative fluid resuscitation rate (mg/kg/h) was less impactful on postoperative ileus, LOS, and AKI than the total amount of intraoperative fluid. A total fluid administration range between 300 mL and 2.7 L was associated with the lowest complication rate. Total intraoperative RL ≥2.7 L was independently associated with a higher risk of ileus (adjusted OR 1.465; 95% confidence interval 1.154-1.858) and prolonged LOS (adjusted OR 1.300; 95% confidence interval 1.047-1.613), but not AKI. Intraoperative RL ≤300 mL was not associated with an increased risk of AKI.ConclusionTotal intraoperative RL ≥2.7 L was independently associated with postoperative ileus and prolonged LOS in elective colorectal surgery patients. A new potential standard for intraoperative fluids will require anesthesia case planning (complexity and duration) to ensure total fluid volume meets this new opportunity to improve care.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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