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- Title
Goal-Directed Fluid Therapy and Postoperative Outcomes in an Enhanced Recovery Program for Colorectal Surgery: A Propensity Score-Matched Multicenter Study.
- Authors
Zorrilla-Vaca, Andres; Mena, Gabriel E.; Ripolles-Melchor, Javier; Abad-Motos, Ane; Aldecoa, Cesar; Lorente, Juan Victor; Ramirez-Rodriguez, José M.; Grant, Michael C.
- Abstract
<bold>Introduction: </bold>Goal-directed fluid therapy (GDFT) has increasingly been utilized in major surgery as a key component to ensure fluid optimization and adequate tissue perfusion, showing improvements in the rate of morbidity and mortality under conventional care. It is unclear if patients derive similar benefit as part of an enhanced recovery program (ERP). Our group sought to assess the association between GDFT and postoperative outcomes within an ERP for colorectal surgery.<bold>Methods: </bold>A propensity score-matched analysis, based upon demographic characteristics, comorbidities, and ERP components, was utilized to assess the association between GDFT and outcomes in a multicenter prospective ERP for colorectal surgery cohort study. Outcomes included pulmonary edema, acute kidney injury (AKI), ileus, surgical site infection (SSI), and anastomotic dehiscence. The calipmatch module was used to match patients who received GDFT to non-GDFT in a 1-to-1 propensity score fashion.<bold>Results: </bold>A total of 151 matched pairs were included in the analysis (n = 302, 23%). Both groups had comparable baseline demographics, as well as similar rates of compliance with enhanced recovery after surgery (ERAS) components. Goal-directed fluid therapy patients received significantly more colloid (237 ± 320 mL vs. 140 ± 245 mL, P < .01) than non-GDFT counterparts. Goal-directed fluid therapy was not associated with improved rates of postoperative AKI (odds ratios (OR) 1.00, 95% confidence intervals (CI) .39-2.59, P = 1.00), ileus (OR 1.40, 95% CI .82-2.41, P = .22), SSI (OR 1.06, 95% CI .54-2.08, P = .86), or length of hospital stay (LOS) (10.8 ± 8.9 vs. 11.1±13.2 days, P = .84).<bold>Conclusions: </bold>There was no associated between GDFT and major postoperative outcomes within an ERAS program for colorectal surgery. Additional large-scale or pragmatic randomized trials are necessary to determine whether GDFT has a role in ERP for colorectal surgery.
- Subjects
FLUID therapy; PROCTOLOGY; ACUTE kidney failure; GOAL (Psychology); SURGICAL site infections; LENGTH of stay in hospitals; PREVENTION of surgical complications; ACUTE kidney failure prevention; COLON diseases; RESEARCH; RECTAL diseases; RESEARCH methodology; PAIRED comparisons (Mathematics); MEDICAL cooperation; EVALUATION research; MEDICAL protocols; COMPARATIVE studies; DIGESTIVE organ surgery; PROBABILITY theory; LONGITUDINAL method
- Publication
American Surgeon, 2021, Vol 87, Issue 8, p1189
- ISSN
0003-1348
- Publication type
journal article
- DOI
10.1177/0003134820973365