@article{article_1692086, title={Which Matters More: Intraoperative or Postoperative Fluid Balance? Insights From a Surgical ICU Cohort}, journal={Harran Üniversitesi Tıp Fakültesi Dergisi}, volume={22}, year={2025}, author={Çolak, Özkul Yılmaz and İşevi, Melda and Sezer Akman, Tuğçehan and Malkoç, Betül and Ünal Akdemir, Neslihan and Ulger, Fatma}, keywords={Fluid therapy, Postoperative period, Intensive careunits}, abstract={Background: Perioperative fluid management is a key component of surgical care, yet the relative impact of intraoperative versus postoperative fluid balance on intensive care unit (ICU) outcomes remains unclear. This study aimed to evaluate the effect of intraoperative, postoperative, and total perioperative fluid balance on major ICU outcomes in patients undergoing elective surgery.
Materials and Methods: This retrospective observational study included 570 adult patients who were admitted intubated to the ICU after elective surgery between January 1 and December 31, 2024. Fluid balance was calculated as a percentage of body weight and categorized into positive (≥5%) or negative-to-normal (<5%) for three time periods: intraoperative, postoperative, and cumulative perioperative. ICU outcomes included mechanical ventilation (MV) duration, ICU length of stay, and ICU mortality. Univariableregression analyses were performed, followed by multivariablelogistic regression to identify independent predictors of ICUmortality.
Results: Positive fluid balance in all three timeframes wassignificantly associated with longer MV duration in unadjustedanalyses. Postoperative and cumulative fluid overload weresignificantly associated with prolonged ICU stay (β=0.23, p=0.021and β=0.11, p=0.014, respectively). Intraoperative fluid percentageshowed a significant inverse association with ICU mortality(OR=0.71, p=0.039), whereas postoperative and cumulativebalances were not. In multivariable analysis, SOFA and APACHEII scores and surgical duration were independently associated withICU mortality. Additionally, total fluid percentage demonstrated astatistically significant inverse association with mortality (OR=0.65,p=0.006).
Conclusions: Postoperative positive fluid balance was the strongestpredictor of adverse ICU outcomes, particularly prolonged ICU stay.Intraoperative positive fluid balance demonstrated an unexpectedinverse relationship with mortality. These findings highlight theimportance of targeted perioperative fluid stewardship and supportthe need for prospective studies to clarify causal relationships.}, number={4}, publisher={Harran University}