Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

Abstract

Background: Individualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery. A limited number of clinical studies have been done in orthopaedic patients and have yielded conflicting results. We designed the present study to investigate the clinical impact of IFM in patients undergoing major spine surgery. Methods: This is a before-after study done in 300 patients undergoing posterior spine arthrodesis. Postoperative outcomes were compared between control group implementing standard fluid management (n = 150) and IFM group (n = 150) guided by fluid protocol based on continuous stroke volume monitoring and optimization. The primary outcome measure was the proportion of patients who developed one or more complications within 30 days following surgery.Results: During surgery, patients received on average the same volume of crystalloids (7.4 vs 7.2 ml/kg/h) and colloids (1.6 vs 1.6 ml/kg/h) before and after the implementation of IFM. During 30 days following surgery, the proportion of patients who developed one or more complications was lower in the IFM group (32 vs 48%, p<0.01). This difference was mainly explained by a significant decrease in post-operative nausea and vomiting (from 38 to 19%, p<0.01), urinary tract infections (from 9 to 1%, p<0.01) and surgical site infections (from 5 to 1%, p<0.05). Median hospital length of stay was not affected by the implementation of IFM. Conclusions: In patients undergoing major spine surgery, the implementation of IFM was associated with a significant decrease in postoperative morbidity.

The Effect of Goal-Directed Fluid Therapy versus Standard Fluid Therapy on the Cuff Leak Gradient in Patients Undergoing Complex Spine Surgery in Prone Position

“…Our study correlates well with previous studies by Bacchin et al and Che et al who found that patients who received GDFT in spine surgery had similar duration of hospital stay as compared with controls despite fewer postoperative complications and lesser duration of ICU stay. 13,14 In our study, we included only ASA physical status I and II patients. Our results are consistent with previous studies which have shown that outcome benefits related to the use of intraoperative GDFT are not limited to high-risk patients.…”