A protocolized-personalized approach for hemodynamics management in major abdominal surgery

Objective. To evaluate the impact of a protocolized-personalized approach to hemodynamic management (PPHM) on 30-day mortality in elderly patients undergoing major abdominal surgery and to determine predictors of mortality. Material and methods. A retrospective-prospective clinical study of PPHM effectiveness in perioperative period of major abdominal surgery in elderly patients was carried out. We analyzed the effect of non-modifiable (gender, age, comorbidities) and modifiable (cardiac index, NT-proBNP, surgery time, duration of anesthesia) factors on 30-day mortality. Results. A total of 90 patients treated with PPHM were eligible for inclusion/exclusion criteria and retrospectively matched with 89 historical control patients with standard postoperative management. There was no significant relationship between PPHM and 30-day mortality (p=0.813). PPHM was followed by shorter ICU-stay (2 (1.0-8.3) days vs. 6 (2.0-16.5) days; p<0.001) and hospital-stay (12 (10-20) days vs. 18 (12-26) days; p<0.001). Multivariate regression analysis identified two independent predictors of mortality: age ≥72 years (adj. OR 12.37; 95% CI 3.38-45.36, p<0.001) and cardiac index at admission ≤2.1 L/min /m2 (adj. OR 4.80; 95% CI 1.28-18.06; p=0.02). Conclusion. Age over 72 years and lower cardiac index at admission (≤2.1 L/min/m2) are associated with higher mortality risk. PPHM in patients undergoing major abdominal surgery was not associated with any changes in 30-day mortality. However, this approach reduces ICU-stay and hospital-stay.