Perioperative oral rehydration therapy is key for improvement of both QoL of patient and hospital revenue

Rationale: Oral supplementation of carbohydrates, electrolytes, water to the patients before surgery is well known to enhance recovery after surgery, as well as minimizing the starvation and dehydration to the body. Methods: Patients, approved by attending physician were scheduled to drink two packs of Arginaid Water (ArW, Nestle Health Science, Japan) on the day of surgery. In the pilot study, 26 patients were randomized into ArW and non-ArW groups. All the patients were measured the amount of gastric contents through nasogastric tube after the introduction of general anesthesia. Based on the results of this study, case adaptation was expanded to all surgical patients in the hospital from November 2011. In addition, limited cases were also allowed to drink OS-1 solution (Otsuka Pharmaceutical Factory, Japan) before drinking ArW and to resume two hours after anesthesia awakening from April 2012. As a result, intravenous infusion in the ward was abolished. Preoperative OS-1 + ArW oral rehydration therapy was expanded to all patients in our hospital in July 2012. Results: In the pilot study, no difference was detected in the amount of gastric contents due to the presence or absence of preoperative rehydration therapy with ArW. We have conducted more than 1,700 cases of pre and postoperative oral rehydration therapy in 18 months by the end of 2012. No adverse event was confirmed in elective surgical cases associated with the oral rehydration therapy. In the Japanese Diagnostic Procedure Combination System, expenses both oral rehydration solutions in the ward claimed as a food material and intravenous transfusion in the operation theater claimed as medical equipment, are contributed to the revenue of the hospital. Conclusion: Aggressive introduction of perioperative oral rehydration therapy is necessary for the improvement of both the QOL of patients and the hospital revenue.