Thacker Julie K M, Mountford William K, Ernst Frank R, Krukas Michelle R, Mythen Michael Monty G
*Department of Surgery, Duke University School of Medicine, Durham, NC †Department of Research Quintiles, Durham, NC ‡Department of Research Premier, Inc, Charlotte, NC §Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals National Institute of Health Research Biomedical Research Centre, London, UK.
Ann Surg. 2016 Mar;263(3):502-10. doi: 10.1097/SLA.0000000000001402.
To study current perioperative fluid administration and associated outcomes in common surgical cohorts in the United States.
An element of enhanced recovery care protocols, optimized perioperative fluid administration may be associated with improved outcomes; however, there is currently no consensus in the United States on fluid use or the effects on outcomes of this use.
The study included all inpatients receiving colon, rectal, or primary hip or knee surgery, 18 years of age or older, who were discharged from a hospital between January 1, 2008 and June, 30 2012 in the Premier Research Database. Patient outcomes and intravenous fluid utilization on the day of surgery were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low day-of-surgery fluids with the likelihood of increased hospital length of stay (LOS), total costs, or postoperative ileus.
The study showed significant associations between high fluid volume given on the day of surgery with both increased LOS (odds ratio 1.10-1.40) and increased total costs (odds ratio 1.10-1.50). High fluid utilization was associated with increased presence of postoperative ileus for both rectal and colon surgery patients. Low fluid utilization was also associated with worse outcomes.
According to results from this review of current practice in US hospitals, fluid optimization would likely lead to decreased variability and improved outcomes.
研究美国常见外科手术队列中当前围手术期的液体管理及相关结果。
作为强化康复护理方案的一个要素，优化围手术期液体管理可能与改善结果相关；然而，目前美国在液体使用及其对结果的影响方面尚未达成共识。
该研究纳入了2008年1月1日至2012年6月30日期间在Premier研究数据库中出院的、年龄在18岁及以上、接受结肠、直肠或初次髋关节或膝关节手术的所有住院患者。对每个手术队列的患者手术当天的结果和静脉输液使用情况进行了总结。建立回归模型以评估手术当天高或低液体量与住院时间（LOS）延长、总费用增加或术后肠梗阻可能性之间的关联。
该研究表明，手术当天给予大量液体与住院时间延长（比值比1.10 - 1.40）和总费用增加（比值比1.10 - 1.50）均存在显著关联。高液体使用量与直肠和结肠手术患者术后肠梗阻的发生率增加有关。低液体使用量也与较差的结果相关。
根据对美国医院当前实践的这项综述结果，液体优化可能会减少变异性并改善结果。
