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The effect of a surgery-specific cardiac output-guided haemodynamic algorithm on outcomes in patients undergoing pancreaticoduodenectomy in a high-volume centre: a retrospective comparative study.
Anaesth Intensive Care. 2017 09; 45(5):569-580.AI

Abstract

In this retrospective observational study performed in a high-volume hepatobiliary-pancreatic unit, we evaluated the effect of a surgery-specific goal-directed therapy (GDT) physiologic algorithm on complications and length of hospital stay. We compared patients who underwent pancreaticoduodenectomy with either a standardised Enhanced Recovery After Surgery program (usual care group), or a standardised Enhanced Recovery After Surgery program in combination with a surgery-specific cardiac output-guided algorithm (GDT group). We included 145 consecutive patients: 47 in the GDT group and 98 in the usual care group. Multivariable associations between GDT and lengths of stay and complications were investigated using negative binomial regression. Postoperative complications were common and occurred at similar frequencies amongst the GDT and usual care groups: 64% versus 68% respectively, P=0.71; odds ratio 0.82; (95% confidence interval 0.39-1.70). There were fewer cardiorespiratory complications in the GDT group. Median (interquartile range) length of hospital stay was ten days (8.0-14.0) in the GDT group compared to 13 days (8.8-21.3) in the usual care group, P=0.01. Median (interquartile range) total intraoperative fluid was 3,000 ml (2,050-4,175) in the GDT group compared to 4,500 ml (3,275-5,325) in the usual care group, P <0.0001; but by day one, the median (interquartile range) fluid balance was similar (1,198 ml [700-1,729] in the GDT group versus 977 ml [419-2,044] in the usual care group, P=0.96). Use of vasoactive medications was higher in the GDT group. In our patients undergoing pancreaticoduodenectomy, GDT was associated with restrictive intraoperative fluid intervention, fewer cardiorespiratory complications and a shorter hospital length of stay compared to usual care. However, we could not exclude an influence of surgical caseload, which we have previously found to be an important variable. We also could not relate the increased hospital length of stay to cardiorespiratory complications in individual patients. Therefore, these observational retrospective findings would require confirmation in a prospective randomised study.

Authors+Show Affiliations

Associate Professor, Departments of Surgery, Austin Hospital, The University of Melbourne.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

28911286

Citation

Weinberg, L, et al. "The Effect of a Surgery-specific Cardiac Output-guided Haemodynamic Algorithm On Outcomes in Patients Undergoing Pancreaticoduodenectomy in a High-volume Centre: a Retrospective Comparative Study." Anaesthesia and Intensive Care, vol. 45, no. 5, 2017, pp. 569-580.
Weinberg L, Banting J, Churilov L, et al. The effect of a surgery-specific cardiac output-guided haemodynamic algorithm on outcomes in patients undergoing pancreaticoduodenectomy in a high-volume centre: a retrospective comparative study. Anaesth Intensive Care. 2017;45(5):569-580.
Weinberg, L., Banting, J., Churilov, L., McLeod, R. L., Fernandes, K., Chao, I., Ho, T., Ianno, D., Liang, V., Muralidharan, V., Christophi, C., & Nikfarjam, M. (2017). The effect of a surgery-specific cardiac output-guided haemodynamic algorithm on outcomes in patients undergoing pancreaticoduodenectomy in a high-volume centre: a retrospective comparative study. Anaesthesia and Intensive Care, 45(5), 569-580.
Weinberg L, et al. The Effect of a Surgery-specific Cardiac Output-guided Haemodynamic Algorithm On Outcomes in Patients Undergoing Pancreaticoduodenectomy in a High-volume Centre: a Retrospective Comparative Study. Anaesth Intensive Care. 2017;45(5):569-580. PubMed PMID: 28911286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of a surgery-specific cardiac output-guided haemodynamic algorithm on outcomes in patients undergoing pancreaticoduodenectomy in a high-volume centre: a retrospective comparative study. AU - Weinberg,L, AU - Banting,J, AU - Churilov,L, AU - McLeod,R L, AU - Fernandes,K, AU - Chao,I, AU - Ho,T, AU - Ianno,D, AU - Liang,V, AU - Muralidharan,V, AU - Christophi,C, AU - Nikfarjam,M, PY - 2017/9/16/entrez PY - 2017/9/16/pubmed PY - 2017/11/29/medline KW - abdominal surgery, cardiovascular monitoring, fluid therapy, surgery SP - 569 EP - 580 JF - Anaesthesia and intensive care JO - Anaesth Intensive Care VL - 45 IS - 5 N2 - In this retrospective observational study performed in a high-volume hepatobiliary-pancreatic unit, we evaluated the effect of a surgery-specific goal-directed therapy (GDT) physiologic algorithm on complications and length of hospital stay. We compared patients who underwent pancreaticoduodenectomy with either a standardised Enhanced Recovery After Surgery program (usual care group), or a standardised Enhanced Recovery After Surgery program in combination with a surgery-specific cardiac output-guided algorithm (GDT group). We included 145 consecutive patients: 47 in the GDT group and 98 in the usual care group. Multivariable associations between GDT and lengths of stay and complications were investigated using negative binomial regression. Postoperative complications were common and occurred at similar frequencies amongst the GDT and usual care groups: 64% versus 68% respectively, P=0.71; odds ratio 0.82; (95% confidence interval 0.39-1.70). There were fewer cardiorespiratory complications in the GDT group. Median (interquartile range) length of hospital stay was ten days (8.0-14.0) in the GDT group compared to 13 days (8.8-21.3) in the usual care group, P=0.01. Median (interquartile range) total intraoperative fluid was 3,000 ml (2,050-4,175) in the GDT group compared to 4,500 ml (3,275-5,325) in the usual care group, P <0.0001; but by day one, the median (interquartile range) fluid balance was similar (1,198 ml [700-1,729] in the GDT group versus 977 ml [419-2,044] in the usual care group, P=0.96). Use of vasoactive medications was higher in the GDT group. In our patients undergoing pancreaticoduodenectomy, GDT was associated with restrictive intraoperative fluid intervention, fewer cardiorespiratory complications and a shorter hospital length of stay compared to usual care. However, we could not exclude an influence of surgical caseload, which we have previously found to be an important variable. We also could not relate the increased hospital length of stay to cardiorespiratory complications in individual patients. Therefore, these observational retrospective findings would require confirmation in a prospective randomised study. SN - 0310-057X UR - https://www.unboundmedicine.com/medline/citation/28911286/The_effect_of_a_surgery_specific_cardiac_output_guided_haemodynamic_algorithm_on_outcomes_in_patients_undergoing_pancreaticoduodenectomy_in_a_high_volume_centre:_a_retrospective_comparative_study_ L2 - http://journals.sagepub.com/doi/full/10.1177/0310057X1704500507?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -