Perioperative Fluid Optimization in Major Abdominal Surgery: A Literature Review

Abstract

Introduction: Optimal fluid management during major abdominal surgery remains debated, with both liberal and restrictive strategies associated with complications. This review evaluates evidence on goal-directed fluid therapy (GDFT) outcomes.
Methods: A systematic search of PubMed, Cochrane Library, and Embase (2015–2024) identified randomized controlled trials and meta-analyses comparing GDFT to conventional fluid regimens in adults undergoing elective major abdominal surgery. Primary outcomes were postoperative ileus and acute kidney injury (AKI).
Results: Fourteen studies (n=3,872) were included. GDFT reduced postoperative ileus duration by 1.2 days (95% CI 0.8–1.6) and lowered AKI incidence (OR 0.62, p=0.01) compared to liberal fluids. Restrictive strategies showed higher AKI risk (OR 1.34) versus GDFT. Dynamic parameters (stroke volume variation) outperformed static ones.
Discussion: GDFT decreases gastrointestinal and renal complications likely via improved splanchnic perfusion and avoidance of fluid overload. Heterogeneity in GDFT protocols (e.g., colloid vs. crystalloid) limits generalizability. Restrictive fluids may compromise renal oxygen delivery.
Conclusions: GDFT using dynamic hemodynamic monitoring is superior to liberal or restrictive regimens for major abdominal surgery. Protocol standardization and implementation science are needed.