Around 4,500 patients in Scotland die every year around the time of surgery and many others suffer ill-health. The provision and delivery of pre- and post-operative care are hypothesised to be major factors in determining outcome. There is evidence that pre-operative optimisation improves outcome and reduces hospital length of stay after surgery. The FOCCUS study was designed as a multi-centred randomised controlled trial to evaluate the roles of (a) intravenous pre-operative fluid loading before high-risk major surgery and (b) differing levels of dependency (high dependency care versus intensive care) in the post-operative period after high-risk surgery, using a partial factorial design.

Due to difficulties obtaining intensive care beds we were unable to complete the level of dependency comparison. Fluid therapy however appeared to reduce the length of time that patients stayed in hospital after surgery (mean difference 5.5 days; p=0.07) although this difference was non-significant. Complications of surgery were less common in these patients and their recovery over the first six months was more rapid with a quicker return to a normal life style. We also found that fluid loading was likely to save money for the health service. On average the reduced NHS costs difference was £1,366. This difference was again not statistically significant but did reflect an 87% likelihood that the fluid intervention would be cost-effective.

The study concluded that fluid therapy before major surgery may improve recovery and it is likely do this in an efficient and cost saving manner, although further research is required to confirm these findings.





Cuthbertson BH, Campbell MK, Stott SA, Elders A, Hernández R, Boyers D, Norrie J, Kinsella J,Brittenden J, Cook J, Rae D, Cotton SC, Alcorn D, Addison J, Grant A; FOCCUS study group.  A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery -the FOCCUS study.  Critical Care. 2011;15(6):R296. doi: 10.1186/cc10592.