Fluid balance in major abdominal surgery deserves more exploration

Professor Myles and his team have published their latest study entitled “Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery” in the New England Journal of Medicine (1). This international study enrolled 2,983 patients undergoing major abdominal surgery in seven countries. The patients were randomized into two groups using different perioperative and postoperative fluid management, and several outcomes were evaluated. The researchers concluded that a significantly higher morbidity rate for acute kidney dysfunction was observed in the restrictive fluid therapy (RFT) group than in the liberal fluid therapy (LFT) group. This indicates that LFT appears to be a better choice for major abdominal surgery patients throughout the perioperative period, which is contrary to the enhanced recovery after surgery (ERAS) recommendations (2-5). We consider this finding warrants further detailed discussion owing to differences with respect to previous published data