Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study
Abstract Background Right hepatectomy is a complex procedure that carries inherent risks of perioperative morbidity. To evaluate outcome differences between a low central venous pressure fluid intervention strategy and a goal directed fluid therapy (GDFT) cardiac output algorithm we performed a retr...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12871-019-0803-x |
| _version_ | 1819020516465311744 |
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| author | Laurence Weinberg Lois Mackley Alexander Ho Steven Mcguigan Damian Ianno Matthew Yii Jonathan Banting Vijayragavan Muralidharan Chong Oon Tan Mehrdad Nikfarjam Chris Christophi |
| author_facet | Laurence Weinberg Lois Mackley Alexander Ho Steven Mcguigan Damian Ianno Matthew Yii Jonathan Banting Vijayragavan Muralidharan Chong Oon Tan Mehrdad Nikfarjam Chris Christophi |
| author_sort | Laurence Weinberg |
| collection | DOAJ |
| description | Abstract Background Right hepatectomy is a complex procedure that carries inherent risks of perioperative morbidity. To evaluate outcome differences between a low central venous pressure fluid intervention strategy and a goal directed fluid therapy (GDFT) cardiac output algorithm we performed a retrospective observational study. We hypothesized that a GDFT protocol would result in less intraoperative fluid administration, reduced complications and a shorter length of hospital stay. Methods Patients undergoing hepatectomy using an established enhanced recovery after surgery (ERAS) programme between 2010 and 2017 were extracted from a prospectively managed electronic hospital database. Inclusion criteria included adult patients, undergoing open right (segments V-VIII) or extended right (segments IV-VIII) hepatectomy. Primary outcome: amount of intraoperative fluid administration used between the two groups. Secondary outcomes: type and amount of vasoactive medications used, the development of predefined postoperative complications, hospital length of stay, and 30-day mortality. Complications were defined by the European Perioperative Clinical Outcome definitions and graded according to Clavien-Dindo classification. The association between GDFT and the amount of fluid and vasoactive medication used was investigated using logistic and linear regression models. Results Fifty-eight consecutive patients were identified. 26 patients received GDFT and 32 received Usual care. There were no significant differences in baseline patient characteristics. Less intraoperative fluid was used in the GDFT group: median (IQR) 2000 ml (1175 to 2700) vs. 2750 ml (2000 to 4000) in the Usual care group; p = 0.03. There were no significant differences in the use of vasoactive medications. Postoperative complications were similar: 9 patients (35%) in the GDFT group vs. 18 patients (56%) in the Usual care group; p = 0.10, OR: 0.41; (95%CI: 0.14 to 1.20). Median (IQR) length of stay for patients in the GDFT group was 7 days (6:8) vs. 9 days (7:13) in the Usual care group; incident rate ratio 0.72 (95%CI: 0.56 to 0.93); p = 0.012. There was no difference in perioperative mortality. Conclusions In patients undergoing open right hepatectomy with an established ERAS programme, use of GDFT was associated with less intraoperative fluid administration and reduced hospital length of stay when compared to Usual care. There were no significant differences in postoperative complications or mortality. Trial registration Australian New Zealand Clinical Trials Registry: no12619000558123 on 10/4/19. |
| first_indexed | 2024-12-21T03:52:27Z |
| format | Article |
| id | doaj.art-235d6b02a1624dfda6febe89ada76be6 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-21T03:52:27Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-235d6b02a1624dfda6febe89ada76be62022-12-21T19:16:55ZengBMCBMC Anesthesiology1471-22532019-07-0119111310.1186/s12871-019-0803-xImpact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational studyLaurence Weinberg0Lois Mackley1Alexander Ho2Steven Mcguigan3Damian Ianno4Matthew Yii5Jonathan Banting6Vijayragavan Muralidharan7Chong Oon Tan8Mehrdad Nikfarjam9Chris Christophi10Department of Anesthesia, Austin HealthDepartment of Anesthesia, Austin HealthDepartment of Anesthesia, Austin HealthDepartment of Anesthesia, Austin HealthDepartment of Anesthesia, Austin HealthDepartment of Anesthesia, Austin HealthDepartment of Anesthesia, Austin HealthDepartment of Surgery, Austin Health, University of MelbourneDepartment of Anesthesia, Austin HealthDepartment of Surgery, Austin Health, University of MelbourneDepartment of Surgery, Austin Health, University of MelbourneAbstract Background Right hepatectomy is a complex procedure that carries inherent risks of perioperative morbidity. To evaluate outcome differences between a low central venous pressure fluid intervention strategy and a goal directed fluid therapy (GDFT) cardiac output algorithm we performed a retrospective observational study. We hypothesized that a GDFT protocol would result in less intraoperative fluid administration, reduced complications and a shorter length of hospital stay. Methods Patients undergoing hepatectomy using an established enhanced recovery after surgery (ERAS) programme between 2010 and 2017 were extracted from a prospectively managed electronic hospital database. Inclusion criteria included adult patients, undergoing open right (segments V-VIII) or extended right (segments IV-VIII) hepatectomy. Primary outcome: amount of intraoperative fluid administration used between the two groups. Secondary outcomes: type and amount of vasoactive medications used, the development of predefined postoperative complications, hospital length of stay, and 30-day mortality. Complications were defined by the European Perioperative Clinical Outcome definitions and graded according to Clavien-Dindo classification. The association between GDFT and the amount of fluid and vasoactive medication used was investigated using logistic and linear regression models. Results Fifty-eight consecutive patients were identified. 26 patients received GDFT and 32 received Usual care. There were no significant differences in baseline patient characteristics. Less intraoperative fluid was used in the GDFT group: median (IQR) 2000 ml (1175 to 2700) vs. 2750 ml (2000 to 4000) in the Usual care group; p = 0.03. There were no significant differences in the use of vasoactive medications. Postoperative complications were similar: 9 patients (35%) in the GDFT group vs. 18 patients (56%) in the Usual care group; p = 0.10, OR: 0.41; (95%CI: 0.14 to 1.20). Median (IQR) length of stay for patients in the GDFT group was 7 days (6:8) vs. 9 days (7:13) in the Usual care group; incident rate ratio 0.72 (95%CI: 0.56 to 0.93); p = 0.012. There was no difference in perioperative mortality. Conclusions In patients undergoing open right hepatectomy with an established ERAS programme, use of GDFT was associated with less intraoperative fluid administration and reduced hospital length of stay when compared to Usual care. There were no significant differences in postoperative complications or mortality. Trial registration Australian New Zealand Clinical Trials Registry: no12619000558123 on 10/4/19.http://link.springer.com/article/10.1186/s12871-019-0803-xAbdominal surgeryHepatectomyRight hepatectomyMonitoringFluid therapySurgery |
| spellingShingle | Laurence Weinberg Lois Mackley Alexander Ho Steven Mcguigan Damian Ianno Matthew Yii Jonathan Banting Vijayragavan Muralidharan Chong Oon Tan Mehrdad Nikfarjam Chris Christophi Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study BMC Anesthesiology Abdominal surgery Hepatectomy Right hepatectomy Monitoring Fluid therapy Surgery |
| title | Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study |
| title_full | Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study |
| title_fullStr | Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study |
| title_full_unstemmed | Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study |
| title_short | Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study |
| title_sort | impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy a single centre retrospective observational study |
| topic | Abdominal surgery Hepatectomy Right hepatectomy Monitoring Fluid therapy Surgery |
| url | http://link.springer.com/article/10.1186/s12871-019-0803-x |
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