Postoperative Intravenous Fluids and Electrolytes Management After Gastrointestinal Surgery in a Sudanese Teaching Hospital: A Prospective Audit

Background: Postoperative fluid and electrolyte management is crucial for adequate patients' recovery and healing. This audit aimed to assess the current practice of postoperative intravenous fluids (IV) and electrolyte administration and investigate postoperative electrolyte disturbances.

Method: This study was conducted at Soba Teaching Hospital and comprised two cycles, it examined adult patients who underwent abdominal surgery and were exclusively on postoperative intravenous fluid therapy for at least one day. Exclusions were made for certain conditions (Heart or renal failure, ICU admissions, day surgeries). Data collected from medical records including intravenous fluid types and amounts, electrolytes, and daily serum sodium and potassium levels, were compared to British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP). Following cycle one, regular educational sessions were conducted for medical staff, emphasizing the need for improved practices in postoperative care.

Results: A total of 14 patients in cycle one and 15 patients in cycle two were included. The data analysis unit was the patient-day. Patient-days refers to the total number of days patients were on IV fluids after surgery, starting from the day after the operation and excluding the day of surgery. It is calculated by adding up the number of days each patient remained exclusively on IV fluids. A total of 33 and 30 patient-days were analyzed in cycle one and cycle two respectively. The recommended daily amount of IV fluids for maintenance was given in 0.00% of patient-days in cycle one as compared to 76.7% in cycle two. Sodium and potassium doses were given within the recommended range of 0.00% and 24% patient-days respectively in cycle one. In cycle two, sodium and potassium were given according to the guidelines in 46.7% and 60% of patient-days respectively. Electrolyte disturbances occurred in 69.7% of patient-days in cycle one, decreasing to 46.7% in cycle two, primarily in the form of hyponatremia and hypokalemia.

Conclusion: This study highlighted the need for continued monitoring and emphasized the importance of adequate medical staff training about postoperative IV fluids and electrolytes.