Myles PS, et al. - Among patients who had an increased risk of complications while undergoing major abdominal surgery, researchers comparatively analyzed the effectiveness of restrictive vs liberal fluid therapy. The data presented in this work showed a restrictive fluid regimen was not linked with a higher rate of disability-free survival than a liberal fluid regimen and was associated with a higher rate of acute kidney injury among patients at increased risk for complications during major abdominal surgery.

Methods

• It was a pragmatic, international trial.
• During and up to 24 hours after surgery, 3,000 patients were randomly assigned who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen.
• Disability-free survival at 1 year was the primary outcome.
• Acute kidney injury at 30 days, renal-replacement therapy at 90 days, and a composite of septic complications, surgical-site infection, or death were the key secondary outcomes.

Results

• One thousand, four hundred ninety patients in the restrictive fluid group had a median intravenous-fluid intake of 3.7 liters (interquartile range, 2.9 to 4.9), as compared with 6.1 liters (interquartile range, 5.0 to 7.4) in one thousand, four hundred ninety-three patients in the liberal fluid group (P < 0.001) during and up to 24 hours after surgery.
• At 1 year, the rate of disability-free survival was 81.9% in the restrictive fluid group and 82.3% in the liberal fluid group (hazard ratio for death or disability, 1.05; 95% confidence interval, 0.88 to 1.24; P=0.61).
• They observed that the rate of acute kidney injury was 8.6% in the restrictive fluid group and 5.0% in the liberal fluid group (P < 0.001).
• Findings revealed that the rate of septic complications or death was 21.8% in the restrictive fluid group and 19.8% in the liberal fluid group (P=0.19).
• According to the findings obtained, rates of surgical-site infection (16.5% vs 13.6%, P=0.02) and renal-replacement therapy (0.9% vs 0.3%, P=0.048) were higher in the restrictive fluid group, yet the between-group difference was not significant after adjustment for multiple testing.