[Perioperative fluid therapy in perforated ulcers].

INTRODUCTION:Surgery for perforated ulcers is one of the most common emergency surgical procedures. Approximately 400 procedures are performed each year in Denmark and mortality is high, reaching close to 30% at 30 days postoperatively. The importance of perioperative fluid administration during the perioperative course remains unclear. The purpose of this study is to describe the perioperative fluid management in these patients in order to identify problem areas (if any) and to create a basis on which future trials on fluid management in this patient group may be designed. MATERIAL AND METHODS:Retrospective survey of 45 consecutive patients operated for perforated ulcers over a 3-year period between 1 January 2003 and 31 December 2005 in the surgical department of a university hospital. RESULTS:Data that would permit rational fluid therapy are not being collected on a regular basis. Fluid balance charts were kept for 42 patients on the day of operation (89%), for 29 patients on the first post-operative day (61%), for 17 patients on the second post-operative day (36%) and for 12 patients (25%) on the third post-operative day. No patients were weighed for assessment of fluid status. Perioperative fluid administration varied extensively, with fluid balance on the day of surgery ranging from -45 to 8,030 ml (median 2688 ml) and a cumulated fluid balance of 7,2 litres (1,875-14,565 ml) three days postoperatively. Generally, patients had no fluid administered prior to surgery (median 0 ml, applying to 41 patients (87%) range 0-4,500 ml). CONCLUSION:Both the preoperative fluid management and the postoperative monitoring of the fluid balance are suboptimal and should be optimized. Individualized (goal-directed) fluid administration aiming at optimizing the oxygen supply to the peripheral tissues is warranted and is recommended to high-risk emergency surgery patients.