Perioperative Fluid Prescription, Complications and Outcomes in Major Elective Open Gastrointestinal Surgery (Original Papers‪)‬

Major elective open gastrointestinal surgery is Common (1). It typically involves elderly patients with multiple comorbid medical conditions (2) and, apart from oesophagectomy, does not usually include routine postoperative management in intensive care (3). These demographic and logistic factors potentially expose patients to a high rate of complications and/or unfavourable outcomes. In particular, in several small studies involving specific subgroups of such patients, investigators have linked perioperative complications with perioperative intravenous fluid therapy (4-14). This link suggests that nonoperative management may be an important determinant of complications, and patient outcome may be amenable to improvement. Yet there is lack of data on current fluid therapy, complications and outcomes. This lack of information makes it very difficult to plan rational and feasible interventions and/or design suitably powered trials to evaluate protective strategies. Accordingly, a greater understanding of perioperative treatment, morbidity and outcomes in major open gastrointestinal surgery is potentially useful. We hypothesised that similar to the findings of a major randomised controlled study (6), in a tertiary Australian hospital in patients having major elective gastrointestinal surgery, comorbidities would be present in more than 30% of cases, cancer would represent the reason for surgery in more than 70% of cases, intravenous fluid therapy would be conservative (fluid prescription less than 31 over first 24 hours), the overall complication rate below 50%, the major complication rate less than 25% and mortality similar to or below 5%. We tested our hypotheses by conducting a retrospective observational study.