TY - JOUR
T1 - Goal-Directed Fluid Therapy and Postoperative Outcomes in an Enhanced Recovery Program for Colorectal Surgery
T2 - A Propensity Score-Matched Multicenter Study
AU - Zorrilla-Vaca, Andres
AU - Mena, Gabriel E.
AU - Ripolles-Melchor, Javier
AU - Abad-Motos, Ane
AU - Aldecoa, Cesar
AU - Lorente, Juan Victor
AU - Ramirez-Rodriguez, José M.
AU - Grant, Michael C.
N1 - Publisher Copyright:
© The Author(s) 2020.
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - colorectal surgery
KW - enhanced recovery pathways
KW - goal-directed fluid therapy
KW - perioperative medicine
KW - postoperative complications
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U2 - 10.1177/0003134820973365
DO - 10.1177/0003134820973365
M3 - Article
C2 - 33342254
AN - SCOPUS:85112530837
SN - 0003-1348
VL - 87
SP - 1189
EP - 1195
JO - American Surgeon
JF - American Surgeon
IS - 8
ER -