Preoperative saline loading improves outcome after elective, noncardiac surgical procedures.

Patients with multiple system disease undergoing elective noncardiac surgical procedures are at variable risk for developing postoperative complications and death. To determine whether preoperative expansion of plasma volume would improve outcome, 306 patients were admitted to the Surgical Intensive Care Unit of the Veterans Administration Center for Swan-Ganz catheter placement and measurement of hemodynamic responses to a 2 L infusion of normal saline over 2 hours. Intraoperative stability and postoperative outcome were assessed by chart review and compared with similar operative groups of patients who did not receive saline infusion. Eighty-eight per cent of the patients had a positive expansion of blood volume with saline infusion. In patients undergoing aortic reconstructive procedures, there was a reduction in the incidence of postoperative complications (52% to 28%) primarily attributed to a reduction in pulmonary complications. In all patients there was an improvement in intraoperative cardiovascular stability (57% saline vs 38% control), a reduction in the need for pharmacologic support of blood pressure (19% saline vs 30% control), and reduction in the amount of intraoperative fluid administration (hydration index: 5.12 saline vs 8.61 control). We therefore conclude that preoperative saline loading is associated with improved outcome in high risk elderly patients undergoing elective, noncardiac surgical procedures.