February 1, 2021Critical CareOpen Access

Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Major visceral/noncardiac surgery (n=2729). Intervention: Perioperative goal-directed therapy (GDT) vs. Standard care / control fluid management. Primary outcome: Overall rate of postoperative complications (pooled risk difference -0.10, 95% CI -0.14 to -0.07, p=< 0.0001).

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Key result

Perioperative goal-directed therapy significantly reduced the overall rate of postoperative complications compared to controls (pooled risk difference -0.10), but did not reduce perioperative mortality.

Why the study?

Appropriate perioperative fluid management reduces postoperative complications, but whether the overall volume infused during goal-directed therapy influences postoperative surgical outcomes is unclear.

Does perioperative goal-directed therapy reduce postoperative complications and perioperative mortality in patients undergoing major visceral/noncardiac surgery?

Population

2729 patients across 21 RCTs in major visceral/noncardiac surgery

Comparison

Perioperative goal-directed therapy approach vs control group

Design

Systematic review and meta-analysis of randomized controlled trials

Authors

AMAntonio MessinaHumanitas University CRChiara RobbaIntensive Care Foundation LCLorenzo CalabróUniversité Libre de Bruxelles

Discussion

Member takes

Implication

GDT reduces postoperative complications irrespective of fluid volume; reinforces routine use in major noncardiac surgery without volume restrictions.

Study Design

Type

Meta-Analysis (n=2,729)

Structured PICO

Does perioperative goal-directed therapy reduce postoperative complications and perioperative mortality in patients undergoing major visceral/noncardiac surgery?

Population

2,729 adult patients undergoing major visceral or noncardiac surgery across 21 randomized controlled trials comparing perioperative goal-directed fluid therapy to standard care.

Intervention

Perioperative goal-directed therapy (GDT) for fluid management, customizing fluid administration based on individual hemodynamic response.

Comparator

Standard care/control group without goal-directed hemodynamic fluid management.

Outcome

Postoperative complications and perioperative mortality.composite

Main Result

Absolute Risk Reduction: 0.1 (95% CI 0.07–0.14)

Absolute Risk Reduction: 10%

p-value: p=< 0.0001

Perioperative goal-directed therapy significantly reduces postoperative complications, but not mortality, in major visceral/noncardiac surgery, irrespective of the total amount of fluid administered.

Limitations

Inconsistency of data reporting postoperative fluid administration, including lack of reporting on oral fluid intake or perioperative maintenance fluid.
Fluid balance was reported in only three of the included studies.
Some concerns regarding risk of bias in the majority (76.2%) of the included studies.
Variation in the definition of postoperative complications and the timing of mortality assessment among the included studies.
Exclusion of some databases (e.g., Web of Science) in the search strategy.

Cite This Study

Messina et al. (2021) conducted a meta-analysis in Major visceral/noncardiac surgery (n=2,729). Perioperative goal-directed therapy (GDT) vs. Standard care / control fluid management was evaluated on Overall rate of postoperative complications (pooled risk difference -0.10, 95% CI -0.14 to -0.07, p=< 0.0001). Perioperative goal-directed therapy significantly reduced the overall rate of postoperative complications compared to controls (pooled risk difference -0.10), but did not reduce perioperative mortality.

synapsesocial.com/papers/6a9033be85f80aee81dd79ca https://doi.org/10.1186/s13054-021-03464-1

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Implication

GDT reduces postoperative complications irrespective of fluid volume; reinforces routine use in major noncardiac surgery without volume restrictions.

Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider