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

Abstract

Background: To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods: Patients, more than 60-year-old, undergoing thoracoscopic pulmonary resection for non small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI) and mean arterial pressure (MAP), maintained the SVV<13%, CI>2.5L/min/m2, and MAP>65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP>65 mmHg. The incidence of postoperative acute kidney injury (AKI), pulmonary and cardiac complications were compared. Results: 276 patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were larger, the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P=0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9±25.2 μmol/L vs 97.1±17.6 μmol/L; P=0.048). Conclusions: Compared to ERAS program with RFT, ERAS program with GDFT has slight beneficial effect on postoperative renal function in elderly patients undergoing thoracoscopic pulmonary resection. Trial registration: Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.

Modern fluid management in thoracic surgery

“…Of these, several showed a benefit in reducing PPCs and length of stay [32,33]. However, as demonstrated by the 2 most recent studies, these benefits are lost when GDFT is used within an ERAS program in keeping with the findings in nonthoracic surgery [34 ▪ ,35 ▪ ]. Importantly, just higher risk patients were included in these last 2 studies and there was no benefit of GDFT in terms of either reduced complications or preservation of renal function.…”