Thu18November0317AM 10

A 58-year-old patient presents for major elective abdominal surgery and is at increased risk of developing postoperative complications.

Which single post-operative outcome is most likely if a restrictive compared with a liberal intravenous fluid regimen is applied during and after surgery?

(Please select 1 option)

Anastomotic leak

Disability free survival at 1-year

Acute kidney injury Correct

Pulmonary oedema

Death at 90 days

Explanation

Early randomised trials suggested the positive benefits of a restrictive fluid regimen in abdominal surgery, with faster return of bowel function, fewer complications and shorter hospital stay.

The results of the restrictive versus liberal fluid therapy for major abdominal surgery trial (RELIEF) were published in The New England Journal of Medicine in June 2018.

It was an international trial comparing outcomes following major abdominal surgery in patients who had increased risk of complications. 3000 patients were randomly allocated to one of two groups.

Restrictive intravenous-fluid regimen during and up to 24-hours after surgery (1490 patients) had a median IV fluid intake of 3.7 litres (interquartile range, 2.9-4.9L)

Liberal intravenous-fluid regimen during and up to 24-hours after surgery (1493 patients) had a median IV fluid intake of 6.1 litres (interquartile range, 5-7.4L)

Primary outcome between the two groups:

Disability free survival at 1-year (P value 0.64)

Secondary outcomes between the two groups:

The most statistically significance between the two groups was the incidence of acute kidney injury. The incidence was 8.6% in the restrictive fluid group and 5.0% in the liberal fluid group (P<0.001).

Other secondary outcomes included:

Anastomotic leak (P value 0.12)

Pulmonary oedema (P value 0.10)

Death at 90 days (P value 0.06)

References:

Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. Myles P. et al. N Engl J Med 2018; 378:2263-2274DOI: 10.1056/NEJMoa1801601.

Answer Statistics

1

6%

2

12%

3

76%

4

4%

5

4%

Times answered: 281