Clinical research on perioperative restrictive fluid therapy combined with preoperative urination training in total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LEI Yiting , HUANG Qiang , ZHANG Shaoyun , CHEN Guo , CAO Guorui ,  PEI Fuxing

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

PEI Fuxing, Email: peifux@126.com

Keywords：

Enhanced recovery after surgery; total hip arthroplasty; restrictive fluid therapy; urination training

DOI：

10.7507/1002-1892.201706012

Video：

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Objective To evaluate the effectiveness and safety of restrictive fluid therapy combined with preoperative urination training during perioperative period in an enhanced recovery after surgery (ERAS) program for primary total hip arthroplasty (THA). Methods A retrospective study were conducted in 73 patients who underwent unilateral THA with liberal intravenous fluid therapy on the day of surgery between April 2015 and March 2016 (control group) and in 70 patients with restrictive fluid therapy and preoperative urination training between November 2016 and April 2017 (trial group). There was no significant difference in gender, age, weight, height, body mass index, primary disease, and complications between 2 groups (P>0.05). Perioperative related indexes were recorded and compared between 2 groups, including operation time; pre-, intra-, post-operative intravenous fluid volumes, overall intravenous fluid volume on the surgery day; postoperative urine volume per hour after surgery; blood volume; total blood loss during perioperative period; usage rates of diuretics and urine tube; the incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery; postoperative length of stay; and the expressions of inflammatory factors [C reaction protein (CRP), interleukin-6 (IL-6)] before sugery and at 1st and 2nd days after surgery. Results The pre-, intra-, post-operative intravenous fluid volumes and the overall intravenous fluid volume on the surgery day in trial group were significantly lower than those in control group (P<0.05). There was no significant difference in operation time, blood volume, total blood loss during perioperative period, and postoperative urine volume per hour after surgery between 2 groups (P>0.05). The usage rates of diuretics and urine tube in trial group were significantly lower than those in control group (P<0.05), while the differences in incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery of 2 groups were insignificant (P>0.05). The level of inflammation factors (CRP, IL-6) at 1st and 2nd days was significant lower in trial group than in control group (P<0.05), with shorter postoperative length of stay (t=–5.529, P=0.000). Conclusion It is safe and effective to adopt restrictive fluid therapy and preoperative urination training during perioperative period (intravenous fluid volume controls in about 1 200 mL on the day of surgery) following ERAS in primary THA. However, prospective studies with large-scale are still in demand for further confirming the conclusion.

Citation： LEI Yiting, HUANG Qiang, ZHANG Shaoyun, CHEN Guo, CAO Guorui, PEI Fuxing. Clinical research on perioperative restrictive fluid therapy combined with preoperative urination training in total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1295-1299. doi: 10.7507/1002-1892.201706012 Copy

1.	Stowers MD, Manuopangai L, Hill AG, et al. Enhanced Recovery After Surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg, 2016, 86(6): 475-479.
2.	Myles P, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial. BMJ Open, 2017, 7(3): e015358.
3.	Schol PB, Terink IM, Lanc? MD, et al. Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis. J Clin Anesth, 2016, 35(1): 26-39.
4.	Hollman F, Wolterbeek N, Veen R. Risk Factors for Postoperative Urinary Retention in Men Undergoing Total Hip Arthroplasty. Orthopedics, 2015, 38(6): e507-511.
5.	Fernandez MA, Karthikeyan S, Wyse M, et al. The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty. Ann R Coll Surg Engl, 2014, 96(6): 462-465.
6.	Bjerregaard LS, Bog? S, Raaschou S, et al. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop, 2015, 86(2): 183-188.
7.	Xie JW, Ma J, Yao H, et al. Multiple Boluses of Intravenous Tranexamic Acid to Reduce Hidden Blood Loss After Primary Total Knee Arthroplasty Without Tourniquet: A Randomized Clinical Trial. J Arthroplasty, 2016, 31(11): 2458-2464.
8.	Pang Q, Liu H, Chen B, et al. Restrictive and liberal fluid administration in major abdominal surgery. Saudi Med J, 2017, 38(2): 123-131.
9.	Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth, 2015, 62(2): 158-168.
10.	Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology, 2005, 103(1): 25-32.
11.	González-Fajardo JA, Mengibar L, Brizuela JA, et al. Effect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery. Eur J Vasc Endovasc Surg, 2009, 37(5): 538-543.
12.	Chatrath V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: Restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol, 2015, 31(3): 308-316.
13.	Duke MD, Guidry C, Guice J, et al. Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation. J Trauma Acute Care Surg, 2012, 73(3): 674-678.
14.	Boland MR, Noorani A, Varty K, et al. Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized, clinical trials. World J Surg, 2013, 37(6): 1193-1202.
15.	Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth, 2002, 89(4): 622-632.
16.	Lau H, Lam B. Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization. ANZ J Surg, 2004, 74(8): 658-661.
17.	季錫清, 賈德前, 聶玉輝, 等. 結直腸癌手術圍術期限制性輸液對術后轉歸影響的觀察. 人民軍醫, 2010, 53(9): 656-657.
18.	Dekker MJ, Marcelli D, Canaud BJ, et al. Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort. Kidney Int, 2017, 91(5): 1214-1223.

1. Stowers MD, Manuopangai L, Hill AG, et al. Enhanced Recovery After Surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg, 2016, 86(6): 475-479.
2. Myles P, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial. BMJ Open, 2017, 7(3): e015358.
3. Schol PB, Terink IM, Lanc? MD, et al. Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis. J Clin Anesth, 2016, 35(1): 26-39.
4. Hollman F, Wolterbeek N, Veen R. Risk Factors for Postoperative Urinary Retention in Men Undergoing Total Hip Arthroplasty. Orthopedics, 2015, 38(6): e507-511.
5. Fernandez MA, Karthikeyan S, Wyse M, et al. The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty. Ann R Coll Surg Engl, 2014, 96(6): 462-465.
6. Bjerregaard LS, Bog? S, Raaschou S, et al. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop, 2015, 86(2): 183-188.
7. Xie JW, Ma J, Yao H, et al. Multiple Boluses of Intravenous Tranexamic Acid to Reduce Hidden Blood Loss After Primary Total Knee Arthroplasty Without Tourniquet: A Randomized Clinical Trial. J Arthroplasty, 2016, 31(11): 2458-2464.
8. Pang Q, Liu H, Chen B, et al. Restrictive and liberal fluid administration in major abdominal surgery. Saudi Med J, 2017, 38(2): 123-131.
9. Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth, 2015, 62(2): 158-168.
10. Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology, 2005, 103(1): 25-32.
11. González-Fajardo JA, Mengibar L, Brizuela JA, et al. Effect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery. Eur J Vasc Endovasc Surg, 2009, 37(5): 538-543.
12. Chatrath V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: Restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol, 2015, 31(3): 308-316.
13. Duke MD, Guidry C, Guice J, et al. Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation. J Trauma Acute Care Surg, 2012, 73(3): 674-678.
14. Boland MR, Noorani A, Varty K, et al. Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized, clinical trials. World J Surg, 2013, 37(6): 1193-1202.
15. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth, 2002, 89(4): 622-632.
16. Lau H, Lam B. Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization. ANZ J Surg, 2004, 74(8): 658-661.
17. 季錫清, 賈德前, 聶玉輝, 等. 結直腸癌手術圍術期限制性輸液對術后轉歸影響的觀察. 人民軍醫, 2010, 53(9): 656-657.
18. Dekker MJ, Marcelli D, Canaud BJ, et al. Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort. Kidney Int, 2017, 91(5): 1214-1223.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical research on perioperative restrictive fluid therapy combined with preoperative urination training in total hip arthroplasty

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