The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial
Abstract Background This study investigated the effects of intraoperative goal-directed hemodynamic therapy (GDHT) on postoperative outcomes in patients undergoing open radical cystectomy. Methods This prospective, single-center, randomized controlled trial included 82 patients scheduled for open ra...
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BMC
2023-10-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-023-02285-9 |
| _version_ | 1797556967546290176 |
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| author | Hyun-Kyu Yoon Min Hur Dong Hyuk Kim Ja Hyeon Ku Jin-Tae Kim |
| author_facet | Hyun-Kyu Yoon Min Hur Dong Hyuk Kim Ja Hyeon Ku Jin-Tae Kim |
| author_sort | Hyun-Kyu Yoon |
| collection | DOAJ |
| description | Abstract Background This study investigated the effects of intraoperative goal-directed hemodynamic therapy (GDHT) on postoperative outcomes in patients undergoing open radical cystectomy. Methods This prospective, single-center, randomized controlled trial included 82 patients scheduled for open radical cystectomy between September 2018 and November 2021. The GDHT group (n = 39) received the stroke volume index- and cardiac index-based hemodynamic management using advanced hemodynamic monitoring, while the control group (n = 36) received the standard care under the discretion of attending anesthesiologists during surgery. The primary outcome was the incidence of a composite of in-hospital postoperative complications during hospital stays. Results A total of 75 patients were included in the final analysis. There was no significant difference in the incidence of in-hospital postoperative complications (28/39 [71.8%] vs. 30/36 [83.3%], risk difference [95% CI], -0.12 [-0.30 to 0.07], P = 0.359) between the groups. The amounts of intraoperative fluid administered were similar between the groups (2700 [2175–3250] vs. 2900 [1950–3700] ml, median difference [95% CI] -200 [-875 to 825], P = 0.714). The secondary outcomes, including the incidence of seven major postoperative complications, duration of hospital stay, duration of intensive care unit stay, and grade of complications, were comparable between the two groups. Trends in postoperative estimated glomerular filtration rate, serum creatinine, and C-reactive protein did not differ significantly between the two groups. Conclusions Intraoperative GDHT did not reduce the incidence of postoperative in-hospital complications during the hospital stay in patients who underwent open radical cystectomy. Trial registration This study was registered at http://www.clinicaltrials.gov (Registration number: NCT03505112; date of registration: 23/04/2018). |
| first_indexed | 2024-03-10T17:10:40Z |
| format | Article |
| id | doaj.art-fe9c142453cb45e1a02a4732a11ca01f |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-10T17:10:40Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-fe9c142453cb45e1a02a4732a11ca01f2023-11-20T10:42:13ZengBMCBMC Anesthesiology1471-22532023-10-0123111010.1186/s12871-023-02285-9The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trialHyun-Kyu Yoon0Min Hur1Dong Hyuk Kim2Ja Hyeon Ku3Jin-Tae Kim4Department of Anesthesiology and Pain Medicine, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Ajou University School of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University College of MedicineAbstract Background This study investigated the effects of intraoperative goal-directed hemodynamic therapy (GDHT) on postoperative outcomes in patients undergoing open radical cystectomy. Methods This prospective, single-center, randomized controlled trial included 82 patients scheduled for open radical cystectomy between September 2018 and November 2021. The GDHT group (n = 39) received the stroke volume index- and cardiac index-based hemodynamic management using advanced hemodynamic monitoring, while the control group (n = 36) received the standard care under the discretion of attending anesthesiologists during surgery. The primary outcome was the incidence of a composite of in-hospital postoperative complications during hospital stays. Results A total of 75 patients were included in the final analysis. There was no significant difference in the incidence of in-hospital postoperative complications (28/39 [71.8%] vs. 30/36 [83.3%], risk difference [95% CI], -0.12 [-0.30 to 0.07], P = 0.359) between the groups. The amounts of intraoperative fluid administered were similar between the groups (2700 [2175–3250] vs. 2900 [1950–3700] ml, median difference [95% CI] -200 [-875 to 825], P = 0.714). The secondary outcomes, including the incidence of seven major postoperative complications, duration of hospital stay, duration of intensive care unit stay, and grade of complications, were comparable between the two groups. Trends in postoperative estimated glomerular filtration rate, serum creatinine, and C-reactive protein did not differ significantly between the two groups. Conclusions Intraoperative GDHT did not reduce the incidence of postoperative in-hospital complications during the hospital stay in patients who underwent open radical cystectomy. Trial registration This study was registered at http://www.clinicaltrials.gov (Registration number: NCT03505112; date of registration: 23/04/2018).https://doi.org/10.1186/s12871-023-02285-9Hemodynamic monitoringGoal-directed hemodynamic therapyRadical cystectomyPostoperative complications |
| spellingShingle | Hyun-Kyu Yoon Min Hur Dong Hyuk Kim Ja Hyeon Ku Jin-Tae Kim The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial BMC Anesthesiology Hemodynamic monitoring Goal-directed hemodynamic therapy Radical cystectomy Postoperative complications |
| title | The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial |
| title_full | The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial |
| title_fullStr | The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial |
| title_full_unstemmed | The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial |
| title_short | The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial |
| title_sort | effect of goal directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy a randomized controlled trial |
| topic | Hemodynamic monitoring Goal-directed hemodynamic therapy Radical cystectomy Postoperative complications |
| url | https://doi.org/10.1186/s12871-023-02285-9 |
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