PractIce pattern of INtraoperative FlUid therapy in elective major gastrointeStinal cancer surgEries in India (I-INFUSE): A multicentre observational study

Background and Aims: Intraoperative fluid therapy is crucial in optimising outcomes after major abdominal surgeries. However, clinical practices vary widely due to uncertainty of appropriate choice of fluid, amount, rate and strategy of fluid administration, and factors like preoperative fluid deficits and intraoperative losses in major abdominal surgeries. Methods: Institutional ethics committee approvals were taken, and this multicentric study was registered with the Clinical Trials Registry-India. In the 3-month observation period, 810 patients undergoing major gastrointestinal (GI) cancer surgery across 30 centres in India were included. Data collected included patient demographics, surgical and anaesthetic details, types and volumes of fluids administered intraoperatively, haemodynamic monitoring, blood loss, transfusions, postoperative complications measured by Clavien–Dindo (CD) classification and Comprehensive Complication Index (CCI), and 30-day readmission. Along with the descriptive statistics, multivariate regression analyses were done to identify predictors outcomes with significance set at P < 0.05. Results: The mean intraoperative fluid administration was 5.34 {standard deviation(SD)}ml/kg/h, and the mean total volume administered was 2648.5 (SD: 1486.6) mL. Postoperative complication rates graded CD ≥3 were observed in 7.9% of patients. Multivariate analysis revealed that lower preoperative serum albumin, higher fluid administration rates, greater blood loss, and intraoperative blood transfusions were independently associated with increased postoperative morbidity and higher CCI scores. Minimally invasive surgery correlated with shorter hospital stays. Conclusion: Fluid therapy practices in major GI cancer surgeries and the mean fluid administration rate of 5.34 (SD: 2.51) mL/kg/h in the intraoperative period at Indian cancer centres align largely with recent international consensus guidelines.