Effects of intraoperative goal-directed fluid therapy in patients receiving bariatric surgery: a systematic review and meta-analysis

To systematically assess the impacts of goal-directed fluid therapy (GDFT) on patients receiving bariatric surgery. A comprehensive search of PubMed, the Cochrane Library, Web of Science, Embase, and Scopus was conducted to identify relevant randomized controlled trials (RCTs). After screening against eligibility criteria, quality assessment, and data extraction, the quality of evidence was assessed using GRADE, followed by a meta-analysis implemented via Stata version 15. A total of eight qualifying RCTs involving 586 patients were included. Meta-analysis revealed that, compared with conventional parameter-guided fluid management, GDFT resulted in a significant increase in intraoperative colloid administration ( SMD = 0.53, 95% CI 0.04–1.02, P z = 0.032) and a decrease in the incidence of postoperative nausea and vomiting (PONV) ( RR = 0.79, 95% CI 0.67–0.92, P z = 0.003). The overall hospital stay did not differ greatly between groups ( SMD = −0.32, 95% CI −0.77–0.13, P z = 0.161). However, shorter stays were observed specifically following laparoscopic sleeve gastrectomy (LSG) and among Asian patients receiving GDFT ( SMD = -0.48, 95% CI −0.90–−0.07, P z = 0.012). No large intergroup differences were found for postoperative lactate levels ( SMD = −0.91, 95% CI −1.84–0.02, P z = 0.054), urine output ( SMD = 1.24, 95% CI −0.32–2.81, P z = 0.12), or intraoperative blood loss ( SMD = −0.31, 95% CI –0.72–0.11, P z = 0.15). Intraoperative GDFT leads to increased colloid administration and a lower risk of PONV in bariatric surgery patients. Subgroup analyses suggested shorter hospital stay after LSG and in Asian patients, despite no overall difference; however, this exploratory finding requires validation in future research.