Abstract
BackgroundGoal-directed hemodynamic therapy (GDHT) has been used in the clinical setting for years. However, the evidence for the beneficial effect of GDHT on postoperative recovery remains inconsistent. The aim of this systematic review and meta-analysis was to evaluate the effect of perioperative GDHT in comparison with conventional fluid therapy on postoperative recovery in adults undergoing major abdominal surgery.MethodsRandomized controlled trials (RCTs) in which researchers evaluated the effect of perioperative use of GDHT on postoperative recovery in comparison with conventional fluid therapy following abdominal surgery in adults (i.e., >16 years) were considered. The effect sizes with 95% CIs were calculated.ResultsForty-five eligible RCTs were included. Perioperative GDHT was associated with a significant reduction in short-term mortality (risk ratio [RR] 0.75, 95% CI 0.61–0.91, p = 0.004, I2 = 0), long-term mortality (RR 0.80, 95% CI 0.64–0.99, p = 0.04, I2 = 4%), and overall complication rates (RR 0.76, 95% CI 0.68–0.85, p < 0.0001, I2 = 38%). GDHT also facilitated gastrointestinal function recovery, as demonstrated by shortening the time to first flatus by 0.4 days (95% CI −0.72 to −0.08, p = 0.01, I2 = 74%) and the time to toleration of oral diet by 0.74 days (95% CI −1.44 to −0.03, p < 0.0001, I2 = 92%).ConclusionsThis systematic review of available evidence suggests that the use of perioperative GDHT may facilitate recovery in patients undergoing major abdominal surgery.
Highlights
Goal-directed hemodynamic therapy (GDHT) has been used in the clinical setting for years
A total of 45 Randomized controlled trial (RCT) were considered for this review (Fig. 1)
In this systematic review and meta-analysis, we found that perioperative GDHT improved survival, reduced overall complication rates, and facilitated GI functional recovery as demonstrated by shortening the time to first flatus pass and the time to toleration of an oral diet compared with conventional fluid therapy when all studies were considered
Summary
Goal-directed hemodynamic therapy (GDHT) has been used in the clinical setting for years. The aim of this systematic review and meta-analysis was to evaluate the effect of perioperative GDHT in comparison with conventional fluid therapy on postoperative recovery in adults undergoing major abdominal surgery. Perioperative fluid management has been recognized as an important factor in postoperative recovery following major abdominal surgery [1, 2]. Goal-directed hemodynamic therapy (GDHT) was proposed by introducing different hemodynamic variables into a dynamic perspective of individual fluid loading with or without vasoactive substances to reach a predefined goal of optimal preload and/or oxygen delivery [5]. An increasing numbers of studies of the effect of perioperative GDHT on postoperative recovery following major abdominal surgery are being done. The evidence for the beneficial effect of GDHT on postoperative recovery remains inconsistent. Several meta-analyses demonstrated that GDHT could decrease postoperative morbidity and
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