Impact of 10% Intra-operative Fluid Overload on Patients Undergoing Major Non-cardiac Surgery and Admitted to General Surgical ICU: A Prospective Observational Study
Suneerat Kongsayreepong MD1, Pongsak Nitikarun MD2, Patrapun Wongsripunetit MD1
Affiliation : 1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Anesthesia Unit, Chanthaburi Hospital, Chanthaburi, Thailand
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 of IFO 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, intra-
abdominal 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 of prolonged 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.
Keywords : Fluid overload, Intra-operation, Non-cardiac surgery, Prolonged ICU stay
