Perioperative fluid therapy

Patient outcomes after major non-cardiac surgery can be improved considerably through more effective perioperative care.1 Factors such as advancing age, comorbidity, and complex surgical procedures can result in postoperative morbidity and mortality rates similar to those found with common acute medical emergencies.1 2 3 Patients who survive postoperative complications experience functional limitation and reduced long term survival.1 2 3 Doctors often prescribe intravenous fluid with limited knowledge of the benefits and risks of this treatment. Doctors in training commonly express frustration at the lack of clear guidance on the optimal approach to fluid therapy. The debate that followed recent UK guidelines aimed at standardising best practice highlights the uncertainty in this area, even among experienced practitioners.4 5

We review the evidence from clinical studies, systematic reviews, and practice guidelines to provide a summary of current best practice in the prescription of fluid for patients undergoing major non-cardiac surgery.