Effect of Goal-Directed Fluid Therapy on the Postoperative Gastrointestinal Function and Length of Stay after Major Abdominal Oncologic Surgery-A Randomized Controlled Trial

Abstract

Background and Objective Postoperative gastrointestinal dysfunction (POGD) is a leading cause of delayed hospital stay after abdominal surgery. Goal-directed fluid therapy (GDFT) may improve gastrointestinal (GI) function, but the evidence for beneficial effects of GDFT for recovery of GI function remains controversial. The aim of this study was to evaluate the effect of GDFT on the postoperative recovery of GI function and length of hospital stay in patients undergoing major abdominal oncologic surgery. Methods In this randomized, partly blinded, controlled trial, adult patients scheduled for elective major abdominal oncologic surgery with general anesthesia, were randomly divided into GDFT group where fluid management was guided by stroke volume variation (SVV) and cardiac output index (CI) and the control group where fluid infusion was given based on conventional fluid therapy. Postoperative GI function was evaluated by Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms (I-FEED) score system and I-FEED score ≥ 6 was defined as POGD. Time to the first flatus, time to first tolerate oral diet and the length of hospital stay were recorded. Results One hundred patients completed the study protocol. Two of 50 patients (4%) developed POGD in the GDFT group, whereas POGD occurred in 16 of 50 patients (32%) in the control group (P < 0.0001). GDFT significantly shorten time to first flatus by 11 hours [GDFT: 28.2 hours (9.2-48.0hours) versus Control: 39.4 hours (24.9–67.5 hours), P = 0.009] and time to first tolerate oral diet by 2 days [GDFT: 4.0 days (2.7-6.0 days) versus Control: 6.0 days (5.0-9.3days), P < 0.0001]. Moreover, the length of hospital stay was significantly shorter in GDFT group compared with the control group [GDFT: 9.0 days (5.8days) versus Control: 12.0 days (4.6days), P = 0.001]. Conclusions GDFT guided by SVV and CI could accelerate the postoperative recovery of GI function and shorten length of hospital stay following major abdominal oncologic surgery.