Goal-Directed Fluid Therapy and Perioperative Epidural Analgesia in Low-Risk Patients Undergoing Elective Colorectal Surgery: Short-Term Clinical Outcomes From a Retrospective-Prospective Cohort Study

Enhanced Recovery After Surgery (ERAS) protocols emphasize perioperative fluid management to optimize outcomes following major abdominal surgery. This study aimed to investigate the effect of thoracic epidural analgesia on hospital length of stay in low-risk patients undergoing open elective colorectal surgery managed with goal-directed fluid therapy (GDFT). A retrospective-prospective single-center cohort study was conducted, enrolling low-risk (American Society of Anesthesiologists (ASA) I-II) patients scheduled for open elective colorectal surgery. Forty-nine patients were prospectively assigned to either GDFT with intravenous analgesia (GDFT group) or GDFT with epidural analgesia (GDFT/ED group). Additionally, 72 patient records managed with conventional fluid therapy (CFT), with (CFT/ED group) or without epidural analgesia (CFT group), were retrospectively reviewed. The primary outcome was length of hospital stay; secondary outcomes included intraoperative fluid administration, gastrointestinal recovery, pro-B-type natriuretic peptide (BNP) levels, and in-hospital mortality. Overall analysis showed shorter hospital stay across groups, which did not reach statistical significance (p=0.08), while pairwise comparison demonstrated significantly shorter stay in the GDFT/ED group compared with the CFT group (p=0.048). Gastrointestinal recovery did not differ significantly between groups, although ileus was more frequent in the CFT and CFT/ED groups. Total intraoperative fluid administration was significantly lower in GDFT-managed patients (p=0.006), with no significant difference between the GDFT and GDFT/ED groups. Baseline and postoperative proBNP levels were comparable across groups, and no in-hospital deaths occurred. In conclusion, among low-risk patients undergoing major open elective colorectal surgery, combining GDFT with thoracic epidural analgesia was associated with a trend toward shorter hospital stay. These findings support integrating individualized fluid optimization with effective analgesia within ERAS protocols even for low-risk patients.