Abstract
BackgroundGoal-directed therapy (GDT) can reduce postoperative complications in high-risk surgery patients. It is uncertain whether GDT has the same benefits in patients undergoing esophageal surgery. Goal of this Quality Improvement study was to evaluate the effects of a stroke volume guided GDT on post-operative outcome.Methods and findingsWe compared the postoperative outcome of patients undergoing esophagectomy before (99 patients) and after (100 patients) implementation of GDT. There was no difference in the proportion of patients with a complication (56% vs. 54%, p = 0.82), hospital stay and mortality. The incidence of prolonged ICU stay (>48 hours) was reduced (28% vs. 12, p = .005) in patients treated with GDT. Secondary analysis of complication rate showed a decrease in pneumonia (29 vs. 15%, p = .02), mediastinal abscesses (12 vs. 3%, p = .02), and gastric tube necrosis (5% vs. 0%, p = .03) in patients treated with GDT. Patients in the GDT group received significantly less fluids but received more colloids.ConclusionsThe implementation of GDT during esophagectomy was not associated with reductions in overall morbidity, mortality and hospital length of stay. However, we observed a decrease in pneumonia, mediastinal abscesses, gastric tube necrosis, and ICU length of stay.
Highlights
Esophagectomy is a high-risk surgical procedure with a morbidity-rate of up to 60% and a 30-day mortality rate ranging between 3 and 5%.[1,2] This high morbidity consists mainly of pulmonary complications, and anastomotic breakdown
Secondary analysis of complication rate showed a decrease in pneumonia (29 vs. 15%, p = .02), mediastinal abscesses (12 vs. 3%, p = .02), and gastric tube necrosis (5% vs. 0%, p = .03) in patients treated with Goal-directed therapy (GDT)
The implementation of GDT during esophagectomy was not associated with reductions in overall morbidity, mortality and hospital length of stay
Summary
Esophagectomy is a high-risk surgical procedure with a morbidity-rate of up to 60% and a 30-day mortality rate ranging between 3 and 5%.[1,2] This high morbidity consists mainly of pulmonary complications, and anastomotic breakdown. These procedures are associated with a long hospital stay and high healthcare costs.[1,3]. Fluid management during thoracic surgical procedures has mainly focused on restricting fluid administration in order to prevent pulmonary complications.[4,5,6,7] A reduction in pulmonary complications has been reported for esophageal surgery in small retrospective studies.[4,6] Of note, a too restrictive approach seems to increase the possibility of other postoperative complications, like anastomotic dehiscence, cardiac ischemia and kidney failure.[8]
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