Randomized clinical trial of fluid restriction in colorectal surgery

Background: Perioperative fluid therapy can influence postoperative hospital stay and complications after elective colorectal surgery. This trial was designed to examine whether an extremely restricted perioperative fluid protocol would reduce hospital stay beyond the existing fast-track hospital time of 7 days after surgery. Methods: Patients were randomized to restricted or standard perioperative intravenous fluid regimens in a single-centre trial. Randomization was stratified for colonic, rectal, open and laparoscopic surgery. Patients were all treated within a fast-track protocol (careful preoperative preparation, optimal analgesia, early oral nutrition and early mobilization). The primary endpoint was length of postoperative hospital stay. The secondary endpoint was complications within 30 days. Results: Seventy-nine patients were randomized to restricted and 82 to standard fluid therapy. Patients in the restricted group received a median of 3050 ml fluid on the day of surgery compared with 5775 ml in the standard group (P < 0.001). There was no difference between groups in primary hospital stay (median 6.0 days in both groups; P = 0.194) or stay including readmission (median 6.0 days in both groups; P = 0.158). The proportion of patients with complications was significantly lower in the restricted group (31 of 79 versus 47 of 82; P = 0.027). Vasopressors were more often required in the restricted group (97 versus 80 per cent; P < 0.001). Conclusion: Restricted perioperative intravenous fluid administration does not reduce length of stay in a fast-track protocol.