Impact of Intra-Operative Fluid Therapy on Short Term Outcomes in Patients Undergoing Advanced Laparoscopic Colorectal Operations Performed for Colorectal Cancer

BACKGROUND There has been a recent shift in the operative approach in advanced colorectal operations where in laparoscopy is being used as the preferred modality of intra-abdominal access. Literature is not clear and there is no consensus with regards to the optimal intraoperative fluid requirements in these operations. Hence, we did a retrospective study of intraoperative fluid requirements for all laparoscopic advanced colorectal resection operations and looked at its impact on short term postoperative recovery. METHODS This is a retrospective analysis of all patients who have undergone advanced laparoscopic colorectal resections in colorectal surgical unit in a single tertiary care centre in south India from January 2014 to June 2017. Data was collected from prospectively maintained electronic inpatient and outpatient charts. The outcomes analysed were postoperative morbidity and length of postoperative hospital stay with respect to intra-operative rate of intravenous (IV) fluid administration. RESULTS There was a total of 201 laparoscopic advanced colorectal resections performed from January 2014 to June 2017. The median IV fluid rate was 5.2 ml/Kg/hr (SD1.97). Seventy nine of 201 patients were documented to have morbidity based on Clavien-Dindo classification. Patients who received intraoperative IV fluids </= 5 ml/Kg/hr were categorised into the restrictive fluid regimen group and patients who received > 5 ml/Kg/hr were categorised into the liberal fluid regimen group. Out of the 79 patients with post-operative morbidity, there was a statistically significant difference between the restrictive fluid group 32/79 (40.5%) and the liberal fluid group 47/79 (59.5%) with a p value of 0.03. CONCLUSIONS Intra-operative liberal fluid management seems to be associated with increased postoperative morbidity in laparoscopic advanced colorectal resections.