Comparison of Goal-Directed Fluid Therapy and Conventional Fluid Therapy in Elective Major Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials

Goal-directed fluid therapy (GDFT) has emerged as an important perioperative strategy aimed at optimizing hemodynamic status and improving surgical outcomes; however, evidence regarding its effectiveness in patients undergoing major abdominal surgery remains variable. This meta-analysis was conducted to evaluate the impact of intraoperative GDFT compared with conventional fluid therapy on postoperative morbidity and clinical outcomes in adult patients undergoing elective major abdominal surgery. Randomized controlled trials comparing GDFT with conventional intraoperative fluid therapy were analyzed. The assessed outcomes included postoperative morbidity, 30-day mortality, length of hospital stay, intensive care unit (ICU) stay, recovery of gastrointestinal function, and incidence of paralytic ileus. A total of 14 randomized controlled trials involving approximately 2,750 patients were included, with 1,433 patients receiving GDFT and 1,317 receiving conventional fluid therapy. GDFT was associated with a significant reduction in hospital length of stay (mean difference (MD) 2.5 days, 95% confidence interval (CI) 4.5 to -0.5), earlier passage of flatus (MD 6.8 hours, 95% CI 11.2 to -2.4), earlier tolerance of oral intake (MD 15.2 hours, 95% CI 26.8 to -3.6), and reduced incidence of postoperative ileus (risk ratio (RR) 0.48, 95% CI 0.28-0.82). However, no significant reduction was observed in overall postoperative morbidity (RR 0.78, 95% CI 0.57-1.07) or mortality (RR 1.02, 95% CI 0.45-2.34). Intraoperative GDFT in elective major abdominal surgery was associated with improved postoperative gastrointestinal recovery, reduced incidence of postoperative ileus, and shorter hospital length of stay compared with conventional fluid therapy. However, no significant reduction in overall postoperative morbidity or mortality was observed. These findings support the use of GDFT as a safe and effective perioperative strategy to enhance postoperative recovery in major abdominal surgery.