Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study
Abstract Background Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. Methods We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intr...
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| Format: | Article |
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BMC
2023-01-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-022-01962-5 |
| _version_ | 1797952379230879744 |
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| author | Morgan Le Guen Amandine Le Gall-Salaun Julien Josserand Augustin Gaudin de Vilaine Simon Viquesnel Damien Muller Bertrand Rozec Kévin Buffenoir Billet Raphaël Cinotti the Société Française d’Anesthésie-Réanimation–SFAR Research Network |
| author_facet | Morgan Le Guen Amandine Le Gall-Salaun Julien Josserand Augustin Gaudin de Vilaine Simon Viquesnel Damien Muller Bertrand Rozec Kévin Buffenoir Billet Raphaël Cinotti the Société Française d’Anesthésie-Réanimation–SFAR Research Network |
| author_sort | Morgan Le Guen |
| collection | DOAJ |
| description | Abstract Background Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. Methods We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS) < 15 and/or history of brain tumour surgery and/or tumour greater size ≥ 35 mm and/or mid-line shift ≥ 3 mm and/or significant haemorrhagic risk. Major postoperative complication was a composite endpoint: re-intubation after surgery, a new onset of GCS < 15 after surgery, focal motor deficit, agitation, seizures, intra-cranial haemorrhage, stroke, intra-cranial hypertension, hospital-acquired related pneumonia, surgical site infection, cardiac arrythmia, invasive mechanical ventilation ≥ 48 h and in-hospital mortality. Results From July 2018 to January 2021, 344 patients were included in 3 centers: 171 in the before and 173 in the after (GDFT) period. Thirty-six (21.1%) patients displayed a major postoperative complication in the Before period, and 50 (28.9%) in the After period (p = 0.1). In the propensity score analysis, we matched 48 patients in each period: 9 (18.8%) patients in the After period and 14 (29.2%) patients in the Before period displayed a major perioperative complication (p = 0.2). Sixty-two (35.8%) patients received GDFT in the After period, with great heterogeneity among centers (p < 0.05). Conclusions In our before-after study, GDFT was not associated with a decrease in postoperative major complications in elective intra-cranial neurosurgery. |
| first_indexed | 2024-04-10T22:46:29Z |
| format | Article |
| id | doaj.art-da7a7adf528449f9bb87b4fc2366fcc5 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-10T22:46:29Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-da7a7adf528449f9bb87b4fc2366fcc52023-01-15T12:19:57ZengBMCBMC Anesthesiology1471-22532023-01-012311710.1186/s12871-022-01962-5Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric studyMorgan Le Guen0Amandine Le Gall-Salaun1Julien Josserand2Augustin Gaudin de Vilaine3Simon Viquesnel4Damien Muller5Bertrand Rozec6Kévin Buffenoir Billet7Raphaël Cinotti8the Société Française d’Anesthésie-Réanimation–SFAR Research NetworkDepartment of Anesthesia, Hôpital FochDepartment of Anaesthesia and Critical Care, CHU Rennes, Hôpital PontchaillouDepartment of Anesthesia, Hôpital FochDepartment of Anaesthesia, Hospital of Saint-NazaireDepartment of Anaesthesia and Critical Care, CHU Rennes, Hôpital PontchaillouDepartment of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôpital LaennecDepartment of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôpital LaennecDepartment of Neuro-Traumatology, CHU Nantes, Nantes UniversitéDepartment of Anaesthesia and Critical Care, CHU Nantes, Nantes UniversitéAbstract Background Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. Methods We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS) < 15 and/or history of brain tumour surgery and/or tumour greater size ≥ 35 mm and/or mid-line shift ≥ 3 mm and/or significant haemorrhagic risk. Major postoperative complication was a composite endpoint: re-intubation after surgery, a new onset of GCS < 15 after surgery, focal motor deficit, agitation, seizures, intra-cranial haemorrhage, stroke, intra-cranial hypertension, hospital-acquired related pneumonia, surgical site infection, cardiac arrythmia, invasive mechanical ventilation ≥ 48 h and in-hospital mortality. Results From July 2018 to January 2021, 344 patients were included in 3 centers: 171 in the before and 173 in the after (GDFT) period. Thirty-six (21.1%) patients displayed a major postoperative complication in the Before period, and 50 (28.9%) in the After period (p = 0.1). In the propensity score analysis, we matched 48 patients in each period: 9 (18.8%) patients in the After period and 14 (29.2%) patients in the Before period displayed a major perioperative complication (p = 0.2). Sixty-two (35.8%) patients received GDFT in the After period, with great heterogeneity among centers (p < 0.05). Conclusions In our before-after study, GDFT was not associated with a decrease in postoperative major complications in elective intra-cranial neurosurgery.https://doi.org/10.1186/s12871-022-01962-5CraniotomyGoal directed fluid therapyOutcomePostoperative complications |
| spellingShingle | Morgan Le Guen Amandine Le Gall-Salaun Julien Josserand Augustin Gaudin de Vilaine Simon Viquesnel Damien Muller Bertrand Rozec Kévin Buffenoir Billet Raphaël Cinotti the Société Française d’Anesthésie-Réanimation–SFAR Research Network Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study BMC Anesthesiology Craniotomy Goal directed fluid therapy Outcome Postoperative complications |
| title | Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study |
| title_full | Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study |
| title_fullStr | Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study |
| title_full_unstemmed | Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study |
| title_short | Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study |
| title_sort | goal directed fluid therapy and major postoperative complications in elective craniotomy a retrospective analysis of a before after multicentric study |
| topic | Craniotomy Goal directed fluid therapy Outcome Postoperative complications |
| url | https://doi.org/10.1186/s12871-022-01962-5 |
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