Effect of Intraoperative Restrictive Fluid Regimes on Outcome after Intraabdominal Surgery: A Meta-Analysis

Objective To evaluate the outcome of patients after intraabdominal surgery with restrictive fluid regimes by the meta analysis. To provide the basis on evidence-based medicine for the fluid treatment and management in the intra-abdominal surgery. Methods Data were obtained by searches of restrictive fluid regimes versus nonrestrictive fluid regimes in intraabdominal selective surgery from CNKI、VIP、Wanfang Data、CBM、PubMed、EMBASE、MEDLINE OvidSP and The Cochrane Library （Issue 3, 2015）, from inception to June 2015. It was undertaken that only randomized controlled trials （RCTs） evaluating the post-operative complications, the duration of hospital stay, time to initial passage of flatus and feces and the laboratory index（including Hb,ALB,BUN,Cr,AST and ALT, etc）. Enumeration data was assessed using risk ratio（RR）, measurement data was assessed using standardized mean difference （SMD）, and each effect sizes were assessed using 95% confidence interval（CI）. Statistical analysis was performed by RevMan5.2. Results A total of 1 681 patients in 16 RCTs. It was found that patients using restrictive fluid regimes had a lower risk of postoperative complications （RR=0.67, 95%CI 0.51~0.41, P=0.003）, a shorter time to initial flatus （SMD=-0.94, 95%CI-1.15~-0.73, P<0.000 01）, a shorter time to initial feces （SMD=-0.92,95%CI -1.14 ~-0.70,P<0.000 01）, the duration of hospital stay （SMD=-0.82,95%CI -1.23~-0.40,P=0.000 1） and the hemoglobin in the first day after surgery（SMD=0.83,95%CI 0.53~1.13,P<0.000 01） compared with those using restrictive fluid regimes. Conclusion The present meta-analysis suggests that the restrictive fluid regimes are helpful to improve the outcome after intra-abdominal surgery and the patients’ health. However, it has no marked influence on the prognosis. Because of the limited quality and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective RCTs.