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Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program.
Clin Nutr ESPEN. 2018 02; 23:184-193.CN

Abstract

BACKGROUND AND AIMS

The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy.

METHODS

This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge.

RESULTS

The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002).

CONCLUSIONS

The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications.

TRIAL REGISTRATION

UMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999.

Authors+Show Affiliations

Department of Nutrition, Faculty of Human Services, Kanagawa University of Human Services, 1-10-1 Heisei, Yokosuka, Kanagawa 238-8522, Japan. Electronic address: hstani@aol.jp.Department of Anaesthesiology, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.Department of Anaesthesiology, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.Department of Anaesthesiology, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.Department of Anaesthesiology, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.Department of Gastrointestinal Surgery, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.Department of Gastrointestinal Surgery, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.Department of Gastrointestinal Surgery, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.Department of Nutrition, Faculty of Human Services, Kanagawa University of Human Services, 1-10-1 Heisei, Yokosuka, Kanagawa 238-8522, Japan.Department of Nutrition, Faculty of Human Services, Kanagawa University of Human Services, 1-10-1 Heisei, Yokosuka, Kanagawa 238-8522, Japan.Department of Anaesthesiology, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29460796

Citation

Taniguchi, Hideki, et al. "Effects of Goal-directed Fluid Therapy On Enhanced Postoperative Recovery: an Interventional Comparative Observational Study With a Historical Control Group On Oesophagectomy Combined With ERAS Program." Clinical Nutrition ESPEN, vol. 23, 2018, pp. 184-193.
Taniguchi H, Sasaki T, Fujita H, et al. Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Clin Nutr ESPEN. 2018;23:184-193.
Taniguchi, H., Sasaki, T., Fujita, H., Kobayashi, H., Kawasaki, R., Ogata, T., Cho, H., Yoshikawa, T., Ushigome, K., Tanaka, A., & Takano, O. (2018). Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Clinical Nutrition ESPEN, 23, 184-193. https://doi.org/10.1016/j.clnesp.2017.10.002
Taniguchi H, et al. Effects of Goal-directed Fluid Therapy On Enhanced Postoperative Recovery: an Interventional Comparative Observational Study With a Historical Control Group On Oesophagectomy Combined With ERAS Program. Clin Nutr ESPEN. 2018;23:184-193. PubMed PMID: 29460796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. AU - Taniguchi,Hideki, AU - Sasaki,Toshio, AU - Fujita,Hisae, AU - Kobayashi,Hiroko, AU - Kawasaki,Rieko, AU - Ogata,Takashi, AU - Cho,Haruhiko, AU - Yoshikawa,Takaki, AU - Ushigome,Keiko, AU - Tanaka,Akemi, AU - Takano,Osami, Y1 - 2017/11/07/ PY - 2017/05/24/received PY - 2017/09/28/revised PY - 2017/10/17/accepted PY - 2018/2/21/entrez PY - 2018/2/21/pubmed PY - 2019/6/1/medline KW - Enhanced recovery after surgery (ERAS) KW - Goal-directed fluid therapy (GDT) KW - Oesophagectomy KW - Postoperative gastrointestinal recovery KW - Postoperative mobilisation SP - 184 EP - 193 JF - Clinical nutrition ESPEN JO - Clin Nutr ESPEN VL - 23 N2 - BACKGROUND AND AIMS: The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. METHODS: This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge. RESULTS: The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002). CONCLUSIONS: The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications. TRIAL REGISTRATION: UMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999. SN - 2405-4577 UR - https://www.unboundmedicine.com/medline/citation/29460796/Effects_of_goal_directed_fluid_therapy_on_enhanced_postoperative_recovery:_An_interventional_comparative_observational_study_with_a_historical_control_group_on_oesophagectomy_combined_with_ERAS_program_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4577(17)30212-7 DB - PRIME DP - Unbound Medicine ER -