Abstract
Perioperative goal-directed therapy is considered to improve patient outcomes after high-risk surgery. The association of compliance with perioperative goal-directed therapy protocols and postoperative outcomes is unclear. The purpose of this study is to determine the effect of protocol compliance on postoperative outcomes following high-risk surgery, after implementation of a perioperative goal-directed therapy protocol. Through a before-after study design, patients undergoing elective high-risk surgery before (before-group) and after implementation of a perioperative goal-directed therapy protocol (after-group) were included. Perioperative goal-directed therapy in the after-group consisted of optimized stroke volume variation or stroke volume index and optimized cardiac index. Additionally, the association of protocol compliance with postoperative complications when using perioperative goal-directed therapy was assessed. High protocol compliance was defined as ≥ 85% of the procedure time spent within the individual targets. The difference in complications during the first 30 postoperative days before and after implementation of the protocol was assessed. In the before-group, 214 patients were included and 193 patients in the after-group. The number of complications was higher in the before-group compared to the after-group (n = 414 vs. 282; p = 0.031). In the after-group, patients with high protocol compliance for stroke volume variation or stroke volume index had less complications compared to patients with low protocol compliance for stroke volume variation or stroke volume index (n = 187 vs. 90; p = 0.01). Protocol compliance by the attending clinicians is essential and should be monitored to facilitate an improvement in postoperative outcomes desired by the implementation of perioperative goal-directed therapy protocols.
Highlights
Perioperative goal-directed therapy aims to optimize the patients hemodynamic status using interventions to reach predefined target values in the perioperative period [1]
*Bonferroni corrected p values of 0.0025 or lower are deemed significant. In this before-and-after study, implementation of a Perioperative goal-directed therapy (pGDT) protocol was associated with a reduction in postoperative complications in patients undergoing high-risk surgery (HRS)
High compliance with the stroke volume variation (SVV) and stroke volume index (SVI) section of the pGDT protocol was associated with a further reduction in mild, moderate and severe postoperative complications
Summary
Perioperative goal-directed therapy (pGDT) aims to optimize the patients hemodynamic status using interventions to reach predefined target values in the perioperative period [1]. Despite such recommendations, pGDT is not yet routinely implemented in clinical practice [11]. One explanatory factor for this discrepancy might be that clinical heterogeneity among trials troubles a clear interpretation of trials evaluating pGDT protocols [12]. The successful implementation of a multimodal protocol does not necessarily translate into improved usage of a protocol
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