Goal-Directed Fluid Therapy and Postoperative Outcomes in an Enhanced Recovery Program for Colorectal Surgery: A Propensity Score-Matched Multicenter Study

Abstract

Introduction Goal-directed fluid therapy (GDFT) has increasingly been utilized in major surgery as a key component to ensure fluid optimization and adequate tissue perfusion, showing improvements in the rate of morbidity and mortality under conventional care. It is unclear if patients derive similar benefit as part of an enhanced recovery program (ERP). Our group sought to assess the association between GDFT and postoperative outcomes within an ERP for colorectal surgery. Methods A propensity score-matched analysis, based upon demographic characteristics, comorbidities, and ERP components, was utilized to assess the association between GDFT and outcomes in a multicenter prospective ERP for colorectal surgery cohort study. Outcomes included pulmonary edema, acute kidney injury (AKI), ileus, surgical site infection (SSI), and anastomotic dehiscence. The calipmatch module was used to match patients who received GDFT to non-GDFT in a 1‐to‐1 propensity score fashion. Results A total of 151 matched pairs were included in the analysis (n = 302, 23%). Both groups had comparable baseline demographics, as well as similar rates of compliance with enhanced recovery after surgery (ERAS) components. Goal-directed fluid therapy patients received significantly more colloid (237 ± 320 mL vs. 140 ± 245 mL, P < .01) than non-GDFT counterparts. Goal-directed fluid therapy was not associated with improved rates of postoperative AKI (odds ratios (OR) 1.00, 95% confidence intervals (CI) .39-2.59, P = 1.00), ileus (OR 1.40, 95% CI .82-2.41, P = .22), SSI (OR 1.06, 95% CI .54-2.08, P = .86), or length of hospital stay (LOS) (10.8 ± 8.9 vs. 11.1±13.2 days, P = .84). Conclusions There was no associated between GDFT and major postoperative outcomes within an ERAS program for colorectal surgery. Additional large-scale or pragmatic randomized trials are necessary to determine whether GDFT has a role in ERP for colorectal surgery.

Perioperative screening and management in elective complex hepatobiliary surgery

“…This study demonstrated that routine CVP monitoring is not essential for all liver resections [39,40 ▪ ]. Systematic reviews, metanalyses and randomized control trials (RCTs) of patients undergoing partial hepatectomy have observed that use of a low CVP was safer and did not result in deleterious effects [38,39,40 ▪ ,41].…”

Clinical study: the impact of goal-directed fluid therapy on volume management during enhanced recovery after surgery in gastrointestinal procedures

“…Due to the current medical model and the roles assigned in implementing the overall ERAS program, anesthesiologists are primarily responsible for controlling and accurately managing the intraoperative stages of fluid management, while preoperative and postoperative fluid management is often carried out by surgeons (Xie et al, 2021). This approach contradicts the concept of continuous and unified fluid management advocated by anesthesiologists during the perioperative period (Weinberg et al, 2019;Zorrilla-Vaca et al, 2021). Regarding nutritional status, in this study, prealbumin levels were found to be 141.98 ± 10.99 mg/L at 3 days after surgery, increasing to 164.17 ± 15.84 mg/L upon discharge from the hospital.…”

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

“…However, the benefit of GDFT often seen in standard care pathways may be masked by ERAS program which can also maintain optimal physiological function. There was no significant difference of AKI incidence after colorectal (Vaca et al 2021 ) and thoracoscopic lobectomy surgery (Li and Peng 2021 ), as well as serum creatinine level after colectomy surgery (Srinivasa et al 2013 ) between GDFT and RFT combined with ERAS program. High-risk patients are more likely to experience postoperative complications and may benefit more from GDFT.…”