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Perioperative Fluid Utilization Variability and Association With Outcomes: Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations

Thacker, Julie K. M. MD; Mountford, William K. PhD; Ernst, Frank R. PharmD, MS; Krukas, Michelle R. MA; Mythen, Michael (Monty) G. MBBS, MD, FRCA, FFICM, FCAI (Hon)

doi: 10.1097/SLA.0000000000001402

Objectives: To study current perioperative fluid administration and associated outcomes in common surgical cohorts in the United States.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: According to results from this review of current practice in US hospitals, fluid optimization would likely lead to decreased variability and improved outcomes.

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*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.

Reprints: Julie K. M. Thacker, MD, Department of Surgery, Duke University School of Medicine, Durham, NC, USA 27710. E-mail:

Disclosure: Supported by funding from Deltex Medical (to W.M., F.E., and M.K.). The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

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