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Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis.
Br J Anaesth. 2013 Apr; 110(4):510-7.BJ

Abstract

BACKGROUND

Perioperative mortality after cardiac surgery has decreased in recent years although postoperative morbidity is still significant. Although there is evidence that perioperative goal-directed haemodynamic therapy (GDT) may reduce surgical mortality and morbidity in non-cardiac surgical patients, the data are less clear after cardiac surgery. The objective of this review is to perform a meta-analysis on the effects of perioperative GDT on mortality, morbidity, and length of hospital stay in cardiac surgical patients.

METHODS

We conducted a systematic review using Medline, EMBASE, and the Cochrane Controlled Clinical Trials Register. Additional sources were sought from experts. The inclusion criteria were randomized controlled trials, mortality reported as an outcome, pre-emptive haemodynamic intervention, and cardiac surgical population. Included studies were examined in full and subjected to quantifiable analysis, subgroup analysis, and sensitivity analysis where possible. Data synthesis was obtained by using odds ratio (OR) and mean difference (MD) for continuous data with 95% confidence interval (CI) utilizing a random-effects model.

RESULTS

From 4986 potential studies, 5 met all the inclusion criteria (699 patients). The quantitative analysis showed that the use of GDT reduced the postoperative complication rate (OR 0.33, 95% CI 0.15-0.73; P=0,006) and hospital length of stay (MD -2.44, 95% CI -4.03 to -0.84; P=0,003). There was no significant reduction in mortality.

CONCLUSION

The use of pre-emptive GDT in cardiac surgery reduces morbidity and hospital length of stay.

Authors+Show Affiliations

St George's Hospital NHS Trust and St George's University of London, London SW170QT, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

23447502

Citation

Aya, H D., et al. "Goal-directed Therapy in Cardiac Surgery: a Systematic Review and Meta-analysis." British Journal of Anaesthesia, vol. 110, no. 4, 2013, pp. 510-7.
Aya HD, Cecconi M, Hamilton M, et al. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2013;110(4):510-7.
Aya, H. D., Cecconi, M., Hamilton, M., & Rhodes, A. (2013). Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. British Journal of Anaesthesia, 110(4), 510-7. https://doi.org/10.1093/bja/aet020
Aya HD, et al. Goal-directed Therapy in Cardiac Surgery: a Systematic Review and Meta-analysis. Br J Anaesth. 2013;110(4):510-7. PubMed PMID: 23447502.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. AU - Aya,H D, AU - Cecconi,M, AU - Hamilton,M, AU - Rhodes,A, Y1 - 2013/02/27/ PY - 2013/3/1/entrez PY - 2013/3/1/pubmed PY - 2013/5/10/medline SP - 510 EP - 7 JF - British journal of anaesthesia JO - Br J Anaesth VL - 110 IS - 4 N2 - BACKGROUND: Perioperative mortality after cardiac surgery has decreased in recent years although postoperative morbidity is still significant. Although there is evidence that perioperative goal-directed haemodynamic therapy (GDT) may reduce surgical mortality and morbidity in non-cardiac surgical patients, the data are less clear after cardiac surgery. The objective of this review is to perform a meta-analysis on the effects of perioperative GDT on mortality, morbidity, and length of hospital stay in cardiac surgical patients. METHODS: We conducted a systematic review using Medline, EMBASE, and the Cochrane Controlled Clinical Trials Register. Additional sources were sought from experts. The inclusion criteria were randomized controlled trials, mortality reported as an outcome, pre-emptive haemodynamic intervention, and cardiac surgical population. Included studies were examined in full and subjected to quantifiable analysis, subgroup analysis, and sensitivity analysis where possible. Data synthesis was obtained by using odds ratio (OR) and mean difference (MD) for continuous data with 95% confidence interval (CI) utilizing a random-effects model. RESULTS: From 4986 potential studies, 5 met all the inclusion criteria (699 patients). The quantitative analysis showed that the use of GDT reduced the postoperative complication rate (OR 0.33, 95% CI 0.15-0.73; P=0,006) and hospital length of stay (MD -2.44, 95% CI -4.03 to -0.84; P=0,003). There was no significant reduction in mortality. CONCLUSION: The use of pre-emptive GDT in cardiac surgery reduces morbidity and hospital length of stay. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/23447502/Goal_directed_therapy_in_cardiac_surgery:_a_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)32718-6 DB - PRIME DP - Unbound Medicine ER -