Goal-Directed Fluid Therapy Does Not Have an Impact on Renal Outcomes in an Enhanced Recovery Program

Background: Goal-directed fluid therapy (GDFT) has been proposed as a cornerstone for enhanced recovery after surgery (ERAS) programs, particularly among high-risk patients undergoing high-risk surgery. However, because of the increased advocacy of euvolemia before surgery, the utility of GDFT in the context of ERAS is being questioned. Our primary objective was to determine whether GDFT has any impact on daily postoperative renal outcomes of high-risk patients undergoing thoracic surgery in an ERAS program. Methods: All patients included in this study were at high risk with a baseline glomerular filtration rate (GFR) below 90 mL/min per 1.73 m² and assigned to American Society of Anesthesiologists class III or class IV. Patients were categorized into 2 groups according to the intraoperative use of GDFT. The groups were matched in a 1:1 fashion using propensity scores. Our renal outcomes included changes in daily GFRs from the postanesthesia care unit through postoperative day 5. Results: In total, 451 matched pairs were included in this analysis. Both groups had similar demographic and clinical characteristics. Patients treated with GDFT received more ephedrine (5 [0-15] mg vs 0 [0-15] mg; P =. 03) and less volume of fluids (1163 ± 484 mL vs 1246 ± 626 mL; P =. 03) compared with those in the standard group. The incidence of acute kidney injury was similar in both groups (5.1% in the GDFT group vs 7.1% in the non-GDFT group; P =. 57). Mixed effect analysis showed no significant differences in the trajectory of postoperative GFRs between groups (P =. 59). Conclusions: GDFT does not have an impact on postoperative renal function compared with standard of care among high-risk patients in an ERAS program for thoracic pulmonary surgery.