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Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UK.

BACKGROUND
Current peri-operative fluid and electrolyte management in the UK may be suboptimal. We assessed the attitudes of consultant surgeons to fluid and electrolyte prescribing and gathered suggestions for improvement in education on the subject.


METHODS
A postal questionnaire survey was sent to 1091 Fellows of the Association of Surgeons of Great Britain and Ireland. Of the 730 (67%) replies, 20 were invalid or incomplete, and 710 (65%) questionnaires were analysed. Outcome measures included provision of guidelines and teaching to junior staff on fluid and electrolyte prescribing, appropriateness of fluid management and suggestions to improve standards.


RESULTS
Junior staff were given written guidelines in 22% of instances. Only 16% of respondents felt that their preregistration house officers (PRHOs) were adequately trained in the subject before joining the firm; 15% also stated that PRHOs did not receive much training on their firm. 65% felt that fluid balance charts were accurately maintained, nursing shortages being the commonest reason for inaccuracies. Only 30% felt that postoperative patients were receiving appropriate amounts of water, sodium and potassium. Respondents who had been consultants for > 5 years were more likely to prefer erring on the side of under-replacement of fluid than those who were consultants for 5 years (63% versus 47%, P < 0.0005). Suggestions for improvement in education included problem-oriented ward rounds, written guidelines, and discussion of patient scenarios.


CONCLUSIONS
Consultant surgeons feel that present practice in peri-operative fluid management is unsatisfactory. Higher standards within clinical governance and risk management may be achieved by focused practical training combined with formal written guidelines.