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The Impact of Long Term Diuretic Therapy on Post-Operative Physiology After Major GI Resection
Daljinder Bajwa*2, Jack J. Gilliland3,1, Michael P. Lewis1
1Upper GI surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom; 2Norwich Medical School, UEA, Norwich, United Kingdom; 3Institute of Food Research, Norwich, United Kingdom
Introduction: Diuretic use is now common in the population. Preoperative diuretic use is associated with increased rates of adverse events and renal dysfunction after cardiac surgery though is very limited information on the effect on the post-operative response following major gastrointestinal surgery.
Aim: the aim of the study was to examine the physiological effect of diuretic therapy on patients who undergo major GI surgery.
Method: Patients enrolled into a large randomised trial of restricted versus liberal intravenous fluid therapy were divided into those taking pre-operative diuretics and those not on diuretics. Changes in the post-operative electrolytes, weight and complications were compared according to randomised group.
Results: A total of 240 patients were enrolled into the study of whom 39 patients were identified as taking a preoperative diuretic (16.25%). Diuretic use was associated with significantly lower serum sodium (p=0.047) and lower serum osmolality in the post-operative period. The mortality rate in patients on diuretics was 7.7% compared to 1.5% in those not on a diuretic (χ2=5.15, p=0.023). There was no difference in other post-operative complications.
Conclusion: Diuretic use may be associated with a higher mortality rate in patients undergoing major GI resectional surgery. The effect of withholding diuretics in the pre-operative period needs further research.
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