Simplified Enhanced Recovery After Surgery Intraoperative Fluid Management.
Hilary Gallin, Marcus V Ortega, Rachel Sisodia, Jason H Wasfy, Jeffrey Ecker, Michael Dezube, Michael K Hidrue, Marcela G Del Carmen, Dan B Ellis
Author Information
Hilary Gallin: Department of Anesthesiology, Weill Cornell School of Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
Marcus V Ortega: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts.
Rachel Sisodia: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Jason H Wasfy: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Jeffrey Ecker: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Michael Dezube: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Michael K Hidrue: Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts.
Marcela G Del Carmen: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts.
Dan B Ellis: Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dbellis@mgb.org.
INTRODUCTION: This study evaluates the efficacy of a simplified intraoperative fluid administration metric within enhanced recovery after surgery (ERAS) pathways. The objective is to optimize fluid management to improve postoperative outcomes, specifically kidney function. METHODS: A retrospective evaluation was conducted at Massachusetts General Hospital on adult patients who underwent open hysterectomy, colectomy, and gastrectomy as part of ERAS pathways. The proposed fluid metric, set at 500 mL/h, was assessed against traditional methods of fluid administration. Data on serum creatinine (Cr) changes as defined as the difference between the baseline value and the maximum value within 1 week of surgery were collected, and compliance with the metric was monitored. Analysis involved Wilcoxon rank-sum test, Kruskal-Wallis test, and quantile regression. RESULTS: The study included 1028 patients. Regression analysis indicated that compared to patients who received the optimal fluid quantity, those receiving below the optimal range showed an absolute increase in median Cr levels of 0.03 mg/dl (95% confidence interval = -0.005, 0.05) while those who received above the optimal range demonstrated an absolute increase in median Cr level of 0.01 (95% confidence interval = -0.03, 0.05). CONCLUSIONS: The new fluid metric demonstrated a balanced approach to fluid administration, reducing the risk of overhydration while maintaining sufficient hydration. Additionally, implementing a simplified fluid metric of 500 mL/h in ERAS pathways is effective in improving postoperative kidney function. This approach facilitates adherence to fluid guidelines and can be applied across various healthcare settings. This metric serves as a practical, evidence-based pathway for fluid administration for most patients undergoing most ERAS procedures.
