Peri-operative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomised clinical trials

Background: Fluid management is a fundamental component of surgical care. Recently, there has been considerable interest in perioperative fluid restriction as a method of facilitating recovery following elective major surgery. A number of randomised trials have addressed the issue in various surgical specialities. Methods: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised controlled trials of peri-operative fluid restriction versus standard peri-operative fluid management in patients undergoing elective major abdominal surgery. The primary outcomes were post-operative complication rates and length of hospital stay. Results: Eight trials containing 749 patients were eligible. Perioperative fluid restriction had no effect on the risk of post-operative complications (pooled odds ratio 0.72; 95% CI 0.331.56; p = 0.40). There was no detectable effect on death and fluid restriction did not reduce hospital stay (weighted mean difference = -1.78 days; 95% CI -3.890.34; p = 0.099). Conclusions: Peri-operative fluid restriction does not significantly reduce the risk of complications following major abdominal surgery. Furthermore, it does not appear to reduce length of hospital stay. Conflict of interest: The authors declare that there are no conflicts of interests Disclosures: The authors declare that there are no disclosures to be made.