Key result
Restrictive fluid therapy significantly decreased the risk of total complications (OR 0.54) and cardiopulmonary dysfunction compared to liberal fluid therapy in patients undergoing major abdominal surgery, although it was associated with an increased risk of kidney injury.
Why the study?
Restrictive fluid therapy is essential to enhanced recovery after surgery, but its safety compared with liberal fluid therapy in major abdominal surgery required systematic evaluation.
Does restrictive fluid therapy reduce complications in adult patients undergoing major abdominal surgery?
Meta-Analysis (n=4,030)
Does restrictive fluid therapy reduce complications in adult patients undergoing major abdominal surgery?
Odds Ratio: 0.54 (95% CI 0.39–0.75)
Absolute Event Rate: 61.5% vs 84.8%
p-value: p=0.0003
Restrictive fluid therapy during major abdominal surgery reduces overall complications and cardiopulmonary dysfunction but increases the risk of acute kidney injury compared to liberal fluid therapy.
Supports restrictive fluids to reduce complications in major abdominal surgery; confirms elevated acute kidney injury risk versus liberal strategy.
Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology : We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Eleven RCTs comparing the two therapies were included. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: Restrictive fluid therapy is safe but may have potential dangers, so caution is warranted in its application.
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Li et al. (2020) conducted a meta-analysis in Major abdominal surgery (n=4,030). Restrictive fluid therapy vs. Liberal fluid therapy (2.8L to 5.4L) was evaluated on Total complications (OR 0.54, 95% CI 0.39-0.75, p=0.0003). Restrictive fluid therapy significantly decreased the risk of total complications (OR 0.54) and cardiopulmonary dysfunction compared to liberal fluid therapy in patients undergoing major abdominal surgery, although it was associated with an increased risk of kidney injury.
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