Perioperative Fluid Restriction in Major Abdominal Surgery: Systematic Review and Meta-analysis of Randomized, Clinical Trials Michael R. Boland • Ayesha Noorani • Kevin Varty • J. Calvin Coffey • Riaz Agha • Stewart R. Walsh Ó Socie ´te ´ Internationale de Chirurgie 2013 Abstract Background Fluid management is a fundamental com- ponent of surgical care. Recently, there has been consid- erable interest in perioperative fluid restriction as a method of facilitating recovery following elective major surgery. A number of randomized trials have addressed the issue in various surgical specialities, and a recent meta-analysis proposed uniform definitions regarding fluid amount as well as examining fluid restriction in patients undergoing colonic resection. Methods Medline, Embase, trial registries, conference proceedings, and article reference lists were searched to identify randomized, controlled trials of perioperative fluid restriction versus ‘‘standard’’ perioperative fluid manage- ment, as per definitions formulated previously. All of the studies involved patients undergoing colonic resection. The primary outcome measure was postoperative morbidity. Secondary endpoints included mortality, renal failure, time to first flatus, and length of hospital stay. A random effects model was applied. Results Seven randomized, controlled trials with a total of 856 patients investigating standard versus restrictive fluid regimes, as denoted by the definitions, were included. Perioperative fluid restriction had no effect on the risk of postoperative complications (OR 0.49 (95 % confidence interval (CI) 0.2–1.18; P = 0.101). There was no detect- able effect on death and fluid restriction did not reduce hospital stay (Pooled weighted mean difference -0.25; 95 % CI 0.72–0.21; P = 0.29). Conclusions Perioperative fluid restriction does not sig- nificantly reduce the risk of complications following major abdominal surgery. Furthermore, it does not appear to reduce length of hospital stay. Introduction Traditional surgical teaching recommends that a 70-kg male requires 1 l of 0.9 % saline and approximately 2 l of 5 % dextrose per day to maintain homeostasis while oral intake is reduced following surgery [1]. In practice, many patients receive larger volumes as the 3 l of intravenous fluids are supplemented by drug infusions and oral intake [1–3]. Excessive postoperative fluid loading, leading to weight gain, is associated with increased complications and mortality [4, 5]. In patients undergoing colorectal surgery, fluid restriction during the perioperative period is thought to have both general and specific advantages. Limiting administration of fluid in this time period has been shown to be effective with regard to postoperative cardiac and respiratory function [6]. More specifically, fluid excess in the perioperative period can impair anastomotic healing [7]. However, there also is evidence to state that periop- erative fluid restriction can impair organ function second- ary to hypovolemia [8]. As part of the ‘‘Enhanced Recovery After Surgery’’ concept developed in the past decade, it was proposed that perioperative fluid restriction would reduce postoperative complications and reduce M. R. Boland (&) Mid-Western Vascular Unit, Mid-Western Regional Hospital, Limerick, Ireland e-mail: mickyboland@gmail.com A. Noorani Á K. Varty Á R. Agha Cambridge Vascular Unit, Addenbrooke’s Hospital, Cambridge, UK J. C. Coffey Á S. R. Walsh Graduate Entry Medical School, University of Limerick, Limerick, Ireland 123 World J Surg DOI 10.1007/s00268-013-1987-8