Abstract

BackgroundRecent literature has demonstrated that hemodynamic instability in the intraoperative period places patients at risk of poor outcomes. Furthermore, recent studies have reported that stroke volume optimization and protocolized hemodynamic management may improve perioperative outcomes, especially surgical site infection (SSI), in certain high-risk populations. However, the optimal strategy for intraoperative management of all elective patients within an enhanced recovery program remains to be elucidated.MethodsWe performed a pre-post quasi-experimental study to assess the effect of adding goal-directed hemodynamic therapy to an enhanced recovery program (ERP) for colorectal surgery on SSI and other outcomes. Three groups were compared: “Pre-ERP,” defined as historical control (before enhanced recovery program); “ERP,” defined as enhanced recovery program using zero fluid balance; and “ERP+GDHT,” defined as enhanced recovery program plus goal-directed hemodynamic therapy. Outcomes were obtained through our National Surgical Quality Improvement Program participation.ResultsA total of 623 patients were included in the final analysis (Pre-ERP = 246, ERP = 140, and ERP + GDHT = 237). Demographics and baseline clinical characteristics were balanced between groups. We did not observe statistically significant differences in SSI or composite complication rates in unadjusted or adjusted analysis. There was no evidence of association between study group and 30-day readmission. American Society of Anesthesiologists status ≥ 3 and open surgical approach were significantly associated with increased risk of SSI, composite complication, and 30-day readmission (p < 0.05 for all) in all groups.ConclusionsThere was no evidence that addition of goal-directed hemodynamic therapy for all patients in an enhanced recovery program for colorectal surgery affects the risk of SSI, composite complications, or 30-day readmission. Further research is needed to investigate whether there is benefit of goal-directed hemodynamic therapy for select high-risk populations.Trial registrationNCT03189550. Registered 16 June 2017–Retrospectively registered, https://www.clinicaltrials.gov/ct2/results?cond=&term=NCT03189550&cntry=&state=&city=&dist=

Highlights

  • Recent literature has demonstrated that hemodynamic instability in the intraoperative period places patients at risk of poor outcomes

  • There was no evidence that addition of goal-directed hemodynamic therapy for all patients in an enhanced recovery program for colorectal surgery affects the risk of surgical site infection (SSI), composite complications, or 30-day readmission

  • Nine patients in the enhanced recovery program (ERP) + goaldirected hemodynamic therapy (GDHT) group did not meet inclusion criteria based upon the actual surgery performed; two patients were excluded as the non-invasive monitor did not function properly; one patient had the case aborted after induction of anesthesia and before incision owing to the development of unstable atrial fibrillation

Read more

Summary

Introduction

Recent literature has demonstrated that hemodynamic instability in the intraoperative period places patients at risk of poor outcomes. Recent studies have reported that stroke volume optimization and protocolized hemodynamic management may improve perioperative outcomes, especially surgical site infection (SSI), in certain high-risk populations. The optimal strategy for intraoperative management of all elective patients within an enhanced recovery program remains to be elucidated. Improving outcomes for surgical patients through goaldirected hemodynamic therapy (GDHT) and enhanced recovery programs (ERPs) has been the focus of major research initiatives for the past 25 years. Three recent large clinical trials have reported positive effects from GDHT for both low to moderate and high-risk surgical patients (Calvo-Vecino et al, 2018; Pearse et al, 2014; Futier et al, 2017)

Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call