Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, 4002University of Texas, TX, USA.
Department of Anesthesiology, Universidad del Valle, Cali, Colombia.
Am Surg. 2021 Aug;87(8):1189-1195. doi: 10.1177/0003134820973365. Epub 2020 Dec 19.
Goal-directed fluid therapy (GDFT) has increasingly been utilized in major surgery as a key component to ensure fluid optimization and adequate tissue perfusion, showing improvements in the rate of morbidity and mortality under conventional care. It is unclear if patients derive similar benefit as part of an enhanced recovery program (ERP). Our group sought to assess the association between GDFT and postoperative outcomes within an ERP for colorectal surgery.
A propensity score-matched analysis, based upon demographic characteristics, comorbidities, and ERP components, was utilized to assess the association between GDFT and outcomes in a multicenter prospective ERP for colorectal surgery cohort study. Outcomes included pulmonary edema, acute kidney injury (AKI), ileus, surgical site infection (SSI), and anastomotic dehiscence. The calipmatch module was used to match patients who received GDFT to non-GDFT in a 1-to-1 propensity score fashion.
A total of 151 matched pairs were included in the analysis (n = 302, 23%). Both groups had comparable baseline demographics, as well as similar rates of compliance with enhanced recovery after surgery (ERAS) components. Goal-directed fluid therapy patients received significantly more colloid (237 ± 320 mL vs. 140 ± 245 mL, < .01) than non-GDFT counterparts. Goal-directed fluid therapy was not associated with improved rates of postoperative AKI (odds ratios (OR) 1.00, 95% confidence intervals (CI) .39-2.59, = 1.00), ileus (OR 1.40, 95% CI .82-2.41, = .22), SSI (OR 1.06, 95% CI .54-2.08, = .86), or length of hospital stay (LOS) (10.8 ± 8.9 vs. 11.1±13.2 days, = .84).
There was no associated between GDFT and major postoperative outcomes within an ERAS program for colorectal surgery. Additional large-scale or pragmatic randomized trials are necessary to determine whether GDFT has a role in ERP for colorectal surgery.
目标导向液体治疗（GDFT）已越来越多地应用于大型手术中，作为确保液体优化和组织灌注充足的关键组成部分，与常规护理相比，它可降低发病率和死亡率。但在加速康复方案（ERP）中，患者是否能获得类似的益处还不清楚。我们的研究旨在评估 GDFT 与结直肠手术后 ERP 中术后结局的关系。
采用倾向评分匹配分析，根据人口统计学特征、合并症和 ERP 成分，评估多中心前瞻性结直肠手术 ERP 队列研究中 GDFT 与结局之间的关系。结局包括肺水肿、急性肾损伤（AKI）、肠梗阻、手术部位感染（SSI）和吻合口裂开。使用 calipmatch 模块以 1:1 的倾向评分方式将接受 GDFT 的患者与未接受 GDFT 的患者进行匹配。
共有 151 对匹配患者纳入分析（n=302，23%）。两组患者的基线人口统计学特征以及接受加速康复后治疗（ERAS）成分的比例均相似。接受 GDFT 的患者接受了明显更多的胶体（237±320ml 比 140±245ml，.01）。与非 GDFT 患者相比，GDFT 并未降低术后 AKI 的发生率（比值比（OR）1.00，95%置信区间（CI）.39-2.59， = 1.00）、肠梗阻（OR 1.40，95% CI.82-2.41， =.22）、SSI（OR 1.06，95% CI.54-2.08， =.86）或住院时间（LOS）（10.8±8.9 比 11.1±13.2 天， =.84）。
在结直肠手术的 ERAS 方案中，GDFT 与主要术后结局之间没有关联。需要进一步开展大规模或实用的随机试验，以确定 GDFT 在结直肠手术的 ERAS 中的作用。
