More IV fluids during surgery is beneficial: RELIEF study

Professor Paul Myles, lead researcher of
the RELIEF study: more IV fluid is good

A global study led by Monash University and The Alfred has found giving patients more IV fluids during surgery can reduce the risk of kidney damage and wound infection post-surgery, solving a decades-old debate.

More than 300 million people worldwide undergo major surgery each year, and anaesthetists have fiercely debated whether to give patients more or less IV fluids during surgery and in the days following. Intravenous (IV) fluids – a “saline drip” – are given to patients to counteract extended periods of not being able to drink or eat before and after surgery, and also to restore the circulation if there is excessive bleeding.

While small studies had previously indicated that limiting IV fluids was beneficial for patients undergoing abdominal surgery, the RELIEF study – conducted across 47 hospitals in seven countries – proved otherwise.

Professor Paul Myles, lead researcher and Director of Anaesthesia and Perioperative Medicine at The Alfred and Monash University, said this study would change anaesthetic procedure across the world.

“The results of this international trial were clear-cut and very reassuring: a more liberal amount of IV fluids protects against kidney damage and reduces the risk of wound infection after surgery,” Professor Myles said.

“The implications for patients are significant – we now know for certain that administering more fluids will lead to substantially better outcomes for patients in the long term.”

The RELIEF study enrolled 3000 people having all types of major abdominal surgery over the past six years.  Half of the patients were given limited IV fluids and the other half were given liberal IV fluids. All study participants were followed up to a year after their operation.

The findings were presented at The Australian and New Zealand College of Anaesthetists (ANZCA) annual scientific meeting on 10 May. The study was funded by the National Health and Medical Research Council (NHMRC) and ANZCA.

Reference
Journal article: Paul S. Myles, M.P.H., D.Sc., Rinaldo Bellomo, M.D., Tomas Corcoran, M.D., Andrew Forbes, Ph.D., Philip Peyton, M.D., Ph.D., David Story, M.D., Chris Christophi, M.B., B.S., Kate Leslie, M.D., Shay McGuinness, M.B., Ch.B., Rachael Parke, M.P.H., Jonathan Serpell, M.D., Matthew T.V. Chan, M.B., B.S., Thomas Painter, M.B., Ch.B., Stuart McCluskey, M.D., Ph.D., Gary Minto, M.B., Ch.B., and Sophie Wallace, M.P.H. for the Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group*. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. New England Journal of Medicine, 10 May 2018. DOI:10.1056/NEJMoa1801601
Podcast of interview: www.periopmedicine.org.au/index.php/podcast