An international study has raised questions about a fluid therapy approach that was previously believed to enhance outcomes during high-risk surgeries.
The findings, published in the BMJ, reveal that this advanced technique fails to reduce postoperative infections and increases the likelihood of abnormal heart rhythms or arrhythmias.
Professor Rupert Pearse from Queen Mary University of London led the OPTIMISE II trial, which was coordinated for publication by Professor Mark Edwards from University Hospital Southampton (UHS).
It involved nearly 2,500 patients aged 65 and older who had pre-existing conditions that increased their surgical risks.
Patients were randomly assigned to receive either fluid therapy, guided by advanced cardiac monitoring, or standard care.
Patients in the fluid therapy group received intravenous fluids through a drip, along with low-dose inotropes, which are medications intended to regulate the strength of heart contractions.
Advanced cardiac monitoring guided fluid administration during surgery and for four hours post-operation.
Despite expectations, the trial showed no decrease in infection rates among these patients compared to those receiving standard care.
Furthermore, a significant number of patients in the fluid therapy group experienced arrhythmias, indicating that the inotrope treatment may carry extra risks.
Based on these findings, the researchers strongly advise against the routine use of this technique in significant planned gastrointestinal surgeries.
With more than 300 million major surgeries performed annually, these results could impact the care of tens of thousands of patients.
In the UK alone, over 50,000 people aged 50 and above undergo major gut surgery annually. Around a third of these patients develop hospital-acquired infections, and many face life-threatening complications within months of surgery.
Professor Edwards said: ‘This was an amazing international effort to get high-quality evidence on this intervention, following decades of uncertainty. Although the approach we trialled was unfortunately not found to be beneficial, we now have clear information that could support practice recommendations impacting many thousands of patients having surgery every year.’
Professor Pearse added: ‘We are delighted to complete this international trial, which brings to a close a decades-long and controversial debate among doctors about how to care for patients who have major surgery. Our findings will guide treatment for tens of thousands of patients each year.’
