Outcome impact of individualized fluid management during spine surgery: a before-after prospective comparison study

Li Xu,Xu Li,Lu Che,Yu G. Huang,Xiu H. Zhang,Yue L. Zhang

doi:10.1186/s12871-020-01092-w

Abstract

BackgroundIndividualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery. A limited number of clinical studies have been done in orthopaedic patients and have yielded conflicting results. We designed the present study to investigate the clinical impact of IFM in patients undergoing major spine surgery.MethodsThis is a before-after study done in 300 patients undergoing posterior spine arthrodesis. Postoperative outcomes were compared between control group implementing standard fluid management (n = 150) and IFM group (n = 150) guided by fluid protocol based on continuous stroke volume monitoring and optimization. The primary outcome measure was the proportion of patients who developed one or more complications within 30 days following surgery.ResultsDuring surgery, patients received on average the same volume of crystalloids (7.4 vs 7.2 ml/kg/h) and colloids (1.6 vs 1.6 ml/kg/h) before and after the implementation of IFM. During 30 days following surgery, the proportion of patients who developed one or more complications was lower in the IFM group (32 vs 48%, p < 0.01). This difference was mainly explained by a significant decrease in post-operative nausea and vomiting (from 38 to 19%, p < 0.01), urinary tract infections (from 9 to 1%, p < 0.01) and surgical site infections (from 5 to 1%, p < 0.05). Median hospital length of stay was not affected by the implementation of IFM.ConclusionIn patients undergoing major spine surgery, the implementation of IFM was associated with a significant decrease in postoperative morbidity.Trial registrationClinicalTrials.gov Identifier: NCT02470221. Prospectively registered on June 12, 2015.

Highlights

Individualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery
The Sample size calculation and statistical analysis Based on the 60% postoperative morbidity rate observed in a sample population from our institution, a power analysis indicated that a sample size of around 150 patients in each group was required to show a 25% relative reduction in postoperative morbidity after IFM implementation, with a power of 0.8 and a type 1 error (α) = 0.05
Continuous normally distributed variables are expressed as mean ± standard deviation (SD), and non-normally distributed continuous variables are expressed as medians

Summary

Introduction

Individualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery. We designed the present study to investigate the clinical impact of IFM in patients undergoing major spine surgery. Intraoperative fluid management is a major determinant of postoperative outcome in various types of surgery [1,2,3]. Che et al BMC Anesthesiology (2020) 20:181 patients undergoing hip fracture surgery, a few studies [13, 14] reported clinical benefits when using IFM, whereas others did not [15, 16]. We designed a before-after comparison study to investigate the impact of IFM implementation on the postoperative outcome of patients undergoing major spine surgery

Methods

Results

Discussion

Conclusion