Key result
Liberal fluids cut AKI ~71% versus restrictive regimens in geriatric major abdominal surgery.
Why the study?
The optimal fluid therapy in elderly patients undergoing major abdominal surgery remains unclear, and evidence is lacking on whether restrictive fluid therapy is suitable for elderly patients.
Does restrictive intravenous-fluid therapy reduce vital organ injury compared to liberal fluid therapy in geriatric patients undergoing major abdominal surgery?
RCT (n=107)
Double-blind
Randomized
No
Does restrictive intravenous-fluid therapy reduce vital organ injury compared to liberal fluid therapy in geriatric patients undergoing major abdominal surgery?
Absolute Event Rate: 10% vs 35.1%
p-value: p=0.002
In geriatric patients undergoing major abdominal surgery, a liberal fluid regimen reduces the risk of AKI and surgical-site infections compared to a restrictive regimen without increasing other postoperative complications.
Liberal fluids may reduce AKI versus restrictive regimens in geriatric abdominal surgery; challenges restrictive fluid consensus.
BACKGROUND: The optimal fluid therapy in elderly patients undergoing major abdominal surgery remains unclear. Although some trials have reported a restrictive fluid therapy may lead to better outcomes, there is no evidence whether it is suitable for elderly patients. METHODS: In a double-blinded pragmatic trial, 107 elderly patients undergoing major abdominal surgery were randomized to receive either a liberal (L group) or restrictive intravenous-fluid therapy (R group) . The postoperative fluid therapy was similar in the two groups. The primary outcome was vital organ injury included Myocardial injury after noncardiac surgery (MINS) and acute kidney injury（AKI）, the secondary outcomes included hypotension needed intervention intraoperatively, length of stay (LOS) , death and other complications defined up to 30 days. Analysis was performed by intention-to-treat. RESULT: 50 patients in the L group had an average intravenous fluid of 1943ml, as compared to 1295.61ml in 57 patients in the R group (P<0.001). The baseline Characteristics and operative details were similar between the groups. Patients in the L group had a lower rate of AKI (10% vs 35.1%, P=0.002) and surgical-site infection (0 vs 10.5%, P=0.029) than in the R group；MINS (20% vs 20.8%, P=0.724) and the other postoperative complications showed no differences between two groups. One patient died in the R group. No significant difference was found for the length of hospital stay[median(range) L: 15(8-49) vs R: 17(8-80); P=0.27]. The follow-up was 30 days. CONCLUSION: In geriatric patients undergoing major abdominal surgery, a liberal fluid regimen was associated with a lower rate of AKI and postoperative infection than restrictive fluid regimen and did not increase the risk of postoperative complications. Trial registration: ChiCTR1800019022.
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CAI et al. (2019) conducted an RCT in Major abdominal surgery (n=107). Liberal fluid therapy vs. Restrictive fluid therapy was evaluated on Acute kidney injury (AKI) (p=0.002). In geriatric patients undergoing major abdominal surgery, a liberal fluid regimen significantly reduced the rate of acute kidney injury compared to a restrictive fluid regimen (10% vs 35.1%, P=0.002).
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