Impact of 10% intra-operative fluid overload on patients undergoing major non-cardiac surgery and admitted to general surgical ICU: A prospective observational study

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: To examine the incidence and effects of intra-operative fluid overloads [IFO] >10% of admission body weight on the incidence of prolonged intensive care unit [ICU] stays (>72 hr); ICU and 90-day mortality rates and perioperative complications. Materials and Methods: A prospective, observational study was conducted on 800 patients admitted to the general surgical ICU from January 2014 to December 2015. Gathered data included patients’ demographic data; admitted and pre-operative serum albumin, hemoglobin [Hb] and creatinine up to 72 hrs; the American Society of Anesthesiologists physical status; surgery type and urgency; anesthesia type and duration; type and amount of intake and output; perioperative complications; septic shock on ICU admission; ventilator days, ICU and hospital lengths of stay, the Acute Physiology and Chronic Health Evaluation II score on postoperative day 1, ICU and 90-day mortality rates. Results: The incidence oflFO was 7.4%. Patients with IFO had significantly longer anesthetic times, lower pre-operative and admitted serum albumin levels; higher preoperative Hb level, fluid balances; longer ICU and longer hospital length of stay. Significantly higher combined general and neuraxial block and septic shock on ICU admission was seen in the IFO patients. Significantly higher perioperative major complications (e.g. congestive heart failure, serious cardiac arrhythmias, intraabdominal hypertension and wound infection) were found in IFO patients. Acute kidney injury was the most organ dysfunction (32.2%) found in IFO patients and 12% needed renal replacement therapy from fluid overload. Ten percent IFO was a significant predictor ofprolonged ICU stay (OR 8.87; 95% CI 4.65 to 16.90,p<0.001) and who had intra-operative fluid balances more than 115 mL/kg were significantly associated with higher 90-day mortality. Conclusion: Ten percent IFO had a high impact in critically ill patients undergoing major non-cardiac surgery in terms of prolonged ICU stay, increasing perioperative major complications, and mortality. Care should be taken to prevent IFO.