ArticleAnnals of surgery2018
Effects of Intraoperative Fluid Management on Postoperative Outcomes: A Hospital Registry Study.
Article in Annals of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 113 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Impact of Goal-directed Hemodynamic Management on Occurrence of Acute and Persistent Kidney Injury After Radical Nephrectomy or Nephroureterectomy: A Randomized Controlled Trial
Optimizing Postoperative Nutrition in Colorectal Surgery: a Prospective Randomized Clinical Trial.
Effects of an Intraoperative Low-splanchnic Blood Volume Restrictive Fluid Management Strategy Compared to a Cardiac Output Optimized Liberal Fluid Management Strategy on Postoperative Outcomes in Liver Transplantation: A Multicenter Randomized Controlled Trial (REFIL-2)
Who cites it
113 citing papers in PubMed, 3 syntheses or guidelines pooled it, 256 citations in OpenAlex.
- Non-invasive goal-directed fluid therapy with the pleth variability index (PVI): a systematic review and meta-analysis.Journal of clinical monitoring and computing · 2025Pooled it
- Restrictive Versus Liberal Fluid Regimens in Patients Undergoing Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2019Pooled it
- Is goal-directed fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? A meta-analysis.Critical care (London, England) · 2018Pooled it
- Effects of Sodium Bicarbonate Ringer's Solution versus Lactate Ringer's Solution on Emergence Time in Patients Undergoing Supratentorial Tumor Resection: A Randomized Controlled Trial.Drug design, development and therapy · 2026Trial
- Effect of isotonic sodium bicarbonate infusion on perioperative acid-base status among patients undergoing emergency laparotomy for perforation peritonitis (ISABEL trial): a randomized controlled trial.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Trial
- Trial
- Enhancement of Pulmonary Function and Reduction of Complications Through EIT-Guided Yoga Breathing Exercise After Esophagectomy.Medical science monitor : international medical journal of experimental and clinical research · 2024Trial
- The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial.BMC anesthesiology · 2023Trial
- Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial.BMC pulmonary medicine · 2023Trial
- Effect of goal-directed fluid therapy based on plasma colloid osmotic pressure on the postoperative pulmonary complications of older patients undergoing major abdominal surgery.World journal of surgical oncology · 2023Trial
- Prospective comparison of the effects of intraoperative goal-directed fluid therapy and restrictive fluid therapy on complications in thoracoscopic lobectomy.The Journal of international medical research · 2021Trial
- Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial.BMC anesthesiology · 2021Trial
- Efficacy of α-Blockers on Hemodynamic Control during Pheochromocytoma Resection: A Randomized Controlled Trial.The Journal of clinical endocrinology and metabolism · 2020Trial
- Gastrointestinal Complications After Pancreatoduodenectomy With Epidural vs Patient-Controlled Intravenous Analgesia: A Randomized Clinical Trial.JAMA surgery · 2020Trial
- Anesthetic Management Using Multiple Closed-loop Systems and Delayed Neurocognitive Recovery: A Randomized Controlled Trial.Anesthesiology · 2020Trial
- Trial
- Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension.Journal of clinical monitoring and computing · 2018Trial
- Best evidence summary on gastrointestinal function recovery after radical cystectomy for bladder cancer.Asia-Pacific journal of oncology nursing · 2026Review
- Standard Intraoperative Fluid Practices During the 2024 Intravenous Fluid Shortage.JAMA network open · 2026Article
- Protective Effect of Diuresis During Hyperthermia on Acute Kidney Injury in Cytoreductive Surgery with HIPEC.Annals of surgical oncology · 2026Article
53 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveEvaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients.
backgroundHealthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols driven by such measures are limited in their ability to define the optimal fluid state during surgery.
methodsThis analysis of data on file included 92,094 adult patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014 at an academic tertiary care hospital and two affiliated community hospitals. The primary exposure variable was total intraoperative volume of crystalloid and colloid administered. The primary outcome was 30-day survival. Secondary outcomes were respiratory complications within three postoperative days (pulmonary edema, reintubation, pneumonia, or respiratory failure) and acute kidney injury. Exploratory outcomes were postoperative length of stay and total cost of care. Our models were adjusted for patient-, procedure-, and anesthesia-related factors.
resultsA U-shaped association was observed between the volume of fluid administered intraoperatively and 30-day mortality, costs, and postoperative length of stay. Liberal fluid volumes (highest quintile of fluid administration practice) were significantly associated with respiratory complications whereas both liberal and restrictive (lowest quintile) volumes were significantly associated with acute kidney injury. Moderately restrictive volumes (second quintile) were consistently associated with optimal postoperative outcomes and were characterized by volumes approximately 40% less than traditional textbook estimates: infusion rates of approximately 6-7 mL/kg/hr or 1 L of fluid for a 3-hour case.
conclusionsIntraoperative fluid dosing at the liberal and restrictive margins of observed practice is associated with increased morbidity, mortality, cost, and length of stay.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.