LAUSR

Background and aim: Colloids administration has been associated with post-operative acute kidney injury and bleeding. Aim of the study is to evaluate if the incidence of re-exploration for bleeding was modified by application of perioperative fluid management protocol with careful balanced crystalloids infusion and colloids administration abolition. Methods: We retrospectively analysed data collected in the Institutional database. 784 patients were considered in the analysis. 459 patients (Group A) underwent cardiac operations before perioperative fluid management protocol was strictly applied and 325 patients (Group B) underwent cardiac operations after protocol application. Results: No differences were found for pre-operative characteristics except for hypertension and NYHA class (higher in A Group). Intraoperative variables were similar in both groups. No differences were found between groups for post operative complications, except for the incidence of re-exploration for bleeding (4.3% vs 1.5%; p:0.02), time on mechanical ventilation (31.3 vs 13.4 hours; p:0.006), sternal wound infection (3.9 vs 0.3%; p:0.02), post-operative pneumonia incidence (2.9 vs 0%; p:0.01), mean RBC units transfused (3.8 vs 2.6 Units; p:0.03) and numbers of patients receiving fresh frozen plasma transfusions (13.7% vs 3.7%; p:0.02), which were higher in Group A. Conclusions: Fluid management protocol application and colloids avoidance significantly reduce re-exploration for bleeding and post-operative blood products use after cardiac surgery.