Goal-Directed Fluid Therapy Enhances Gastrointestinal Recovery after Laparoscopic Surgery: A Systematic Review and Meta-Analysis

Figure 1. PRISMA flowchart of selection.

Figure 2. Length of hospital stay (days). Length of hospital stay was significantly shorter in patients who received GDFT (WMD = −1.18 days; 95% CI = −1.84 days to −0.53 days) and also in the non-ERAS subgroup (WMD = −1.28 days; 95% CI = −2.12 days to −0.44 days). However, in the ERAS subgroup, our result was not significant (WMD = −1.18 days; 95% CI = −2.79 days to 0.43 days). Heterogeneity was high both in overall and in the non-ERAS group (I-squared = 80.1%; p < 0.01 and I-squared = 85.5%; p < 0.01), and moderate in the ERAS subgroup (I-squared = 64.4%; p = 0.06).

Figure 3. Time to first stool and time to first flatus. Time to first stool (A) was significantly reduced in patients receiving GDFT compared to the controls (WMD = −9.81 h; 95%; CI = −12.66 h to −6.97 h). No evidence was found for heterogeneity (I-squared = 0.0%; p = 0.85). Time to first flatus (B) was significantly shortened in the GDFT group compared to the controls (WMD = −5.63 h; 95% CI = −10.87 h to 0.38 h). High heterogeneity was detected (I-squared = 92.0%; p < 0.01). WMD: weighted mean difference, SD: standard deviation, GDFT: goal-directed fluid therapy, N-GDFT: non-goal-directed fluid therapy, CI: confidence interval. p < 0.1 was considered significant.

Figure 4. Clinical outcomes at the end of operation. Intraoperative fluid requirement (A) was significantly lower (WMD = −440.84 mL; 95% CI: −789.73 mL to −91.96 mL) in the GDFT group. High heterogeneity was detected (I-squared = 96.9%, p < 0.01). There was no significant difference in the number of patients requiring vasopressors intraoperatively (B) between the goal- and the non-goal-directed groups. (RR = 0.90; 95% CI = 0.71 to 1.14). Low heterogeneity was found (I-squared = 44.0%; p < 0.01). There was no significant difference in intraoperative urinary output standardised for length of surgery (C) between the two groups (SMD = 5.69 mL h−1; 95% CI = −2.16 mL h−1 to 13.54 mL h−1). Data were not considered heterogeneous (I-squared = 0.0%; p = 0.96). Serum lactate levels (D) were significantly lower in the GDFT group compared to N-GDFT (WMD = −0.25 mmol L−1; 95% CI −0.36 mmol/ to −0.14 mmol L−1). There is no evidence for heterogeneity (I-squared = 42.7%; p = 0.18). WMD: weighted mean difference, SMD: standardised mean difference, RR: risk ratio, SD: standard deviation. GDFT: goal-directed fluid therapy, N-GDFT: non-goal-directed fluid therapy, CI: confidence interval. p < 0.1 was…