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Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study.
BMC Anesthesiol. 2019 07 31; 19(1):135.BA

Abstract

BACKGROUND

Right hepatectomy is a complex procedure that carries inherent risks of perioperative morbidity. To evaluate outcome differences between a low central venous pressure fluid intervention strategy and a goal directed fluid therapy (GDFT) cardiac output algorithm we performed a retrospective observational study. We hypothesized that a GDFT protocol would result in less intraoperative fluid administration, reduced complications and a shorter length of hospital stay.

METHODS

Patients undergoing hepatectomy using an established enhanced recovery after surgery (ERAS) programme between 2010 and 2017 were extracted from a prospectively managed electronic hospital database. Inclusion criteria included adult patients, undergoing open right (segments V-VIII) or extended right (segments IV-VIII) hepatectomy.

PRIMARY OUTCOME

amount of intraoperative fluid administration used between the two groups.

SECONDARY OUTCOMES

type and amount of vasoactive medications used, the development of predefined postoperative complications, hospital length of stay, and 30-day mortality. Complications were defined by the European Perioperative Clinical Outcome definitions and graded according to Clavien-Dindo classification. The association between GDFT and the amount of fluid and vasoactive medication used was investigated using logistic and linear regression models.

RESULTS

Fifty-eight consecutive patients were identified. 26 patients received GDFT and 32 received Usual care. There were no significant differences in baseline patient characteristics. Less intraoperative fluid was used in the GDFT group: median (IQR) 2000 ml (1175 to 2700) vs. 2750 ml (2000 to 4000) in the Usual care group; p = 0.03. There were no significant differences in the use of vasoactive medications. Postoperative complications were similar: 9 patients (35%) in the GDFT group vs. 18 patients (56%) in the Usual care group; p = 0.10, OR: 0.41; (95%CI: 0.14 to 1.20). Median (IQR) length of stay for patients in the GDFT group was 7 days (6:8) vs. 9 days (7:13) in the Usual care group; incident rate ratio 0.72 (95%CI: 0.56 to 0.93); p = 0.012. There was no difference in perioperative mortality.

CONCLUSIONS

In patients undergoing open right hepatectomy with an established ERAS programme, use of GDFT was associated with less intraoperative fluid administration and reduced hospital length of stay when compared to Usual care. There were no significant differences in postoperative complications or mortality.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: no 12619000558123 on 10/4/19.

Authors+Show Affiliations

Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia. laurence.weinberg@austin.org.au. Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia. laurence.weinberg@austin.org.au.Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.

Pub Type(s)

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

Language

eng

PubMed ID

31366327

Citation

Weinberg, Laurence, et al. "Impact of a Goal Directed Fluid Therapy Algorithm On Postoperative Morbidity in Patients Undergoing Open Right Hepatectomy: a Single Centre Retrospective Observational Study." BMC Anesthesiology, vol. 19, no. 1, 2019, p. 135.
Weinberg L, Mackley L, Ho A, et al. Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study. BMC Anesthesiol. 2019;19(1):135.
Weinberg, L., Mackley, L., Ho, A., Mcguigan, S., Ianno, D., Yii, M., Banting, J., Muralidharan, V., Tan, C. O., Nikfarjam, M., & Christophi, C. (2019). Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study. BMC Anesthesiology, 19(1), 135. https://doi.org/10.1186/s12871-019-0803-x
Weinberg L, et al. Impact of a Goal Directed Fluid Therapy Algorithm On Postoperative Morbidity in Patients Undergoing Open Right Hepatectomy: a Single Centre Retrospective Observational Study. BMC Anesthesiol. 2019 07 31;19(1):135. PubMed PMID: 31366327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study. AU - Weinberg,Laurence, AU - Mackley,Lois, AU - Ho,Alexander, AU - Mcguigan,Steven, AU - Ianno,Damian, AU - Yii,Matthew, AU - Banting,Jonathan, AU - Muralidharan,Vijayragavan, AU - Tan,Chong Oon, AU - Nikfarjam,Mehrdad, AU - Christophi,Chris, Y1 - 2019/07/31/ PY - 2019/04/26/received PY - 2019/07/12/accepted PY - 2019/8/2/entrez PY - 2019/8/2/pubmed PY - 2020/4/9/medline KW - Abdominal surgery KW - Fluid therapy KW - Goal directed therapy KW - Hepatectomy KW - Monitoring KW - Right hepatectomy KW - Surgery SP - 135 EP - 135 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 19 IS - 1 N2 - BACKGROUND: Right hepatectomy is a complex procedure that carries inherent risks of perioperative morbidity. To evaluate outcome differences between a low central venous pressure fluid intervention strategy and a goal directed fluid therapy (GDFT) cardiac output algorithm we performed a retrospective observational study. We hypothesized that a GDFT protocol would result in less intraoperative fluid administration, reduced complications and a shorter length of hospital stay. METHODS: Patients undergoing hepatectomy using an established enhanced recovery after surgery (ERAS) programme between 2010 and 2017 were extracted from a prospectively managed electronic hospital database. Inclusion criteria included adult patients, undergoing open right (segments V-VIII) or extended right (segments IV-VIII) hepatectomy. PRIMARY OUTCOME: amount of intraoperative fluid administration used between the two groups. SECONDARY OUTCOMES: type and amount of vasoactive medications used, the development of predefined postoperative complications, hospital length of stay, and 30-day mortality. Complications were defined by the European Perioperative Clinical Outcome definitions and graded according to Clavien-Dindo classification. The association between GDFT and the amount of fluid and vasoactive medication used was investigated using logistic and linear regression models. RESULTS: Fifty-eight consecutive patients were identified. 26 patients received GDFT and 32 received Usual care. There were no significant differences in baseline patient characteristics. Less intraoperative fluid was used in the GDFT group: median (IQR) 2000 ml (1175 to 2700) vs. 2750 ml (2000 to 4000) in the Usual care group; p = 0.03. There were no significant differences in the use of vasoactive medications. Postoperative complications were similar: 9 patients (35%) in the GDFT group vs. 18 patients (56%) in the Usual care group; p = 0.10, OR: 0.41; (95%CI: 0.14 to 1.20). Median (IQR) length of stay for patients in the GDFT group was 7 days (6:8) vs. 9 days (7:13) in the Usual care group; incident rate ratio 0.72 (95%CI: 0.56 to 0.93); p = 0.012. There was no difference in perioperative mortality. CONCLUSIONS: In patients undergoing open right hepatectomy with an established ERAS programme, use of GDFT was associated with less intraoperative fluid administration and reduced hospital length of stay when compared to Usual care. There were no significant differences in postoperative complications or mortality. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: no 12619000558123 on 10/4/19. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/31366327/Impact_of_a_goal_directed_fluid_therapy_algorithm_on_postoperative_morbidity_in_patients_undergoing_open_right_hepatectomy:_a_single_centre_retrospective_observational_study_ L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0803-x DB - PRIME DP - Unbound Medicine ER -