Effect of cardiac-index guided intraoperative haemodynamic therapy on postoperative outcome in non-cardiac surgery patients – a systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Adult patients undergoing elective non-cardiac surgery (n=3204). Intervention: Cardiac Index-guided goal-directed therapy (CI-GDT) vs. Standard or usual perioperative haemodynamic care. Primary outcome: Incidence of patients experiencing at least one postoperative complication (composite outcome) (OR 0.59, 95% CI 0.45-0.78).

Q: What does this research mean for the field?

Cardiac index-guided goal-directed therapy reduces the incidence of postoperative complications compared with standard care in adult non-cardiac surgery, though it does not significantly affect mortality. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Philipp Kazuo Omuro; Hanns‐Christian Dinges; Tobias Kammerer

doi:10.1186/s13741-026-00760-8

November 7, 2026Perioperative MedicineOpen Access

Effect of cardiac-index guided intraoperative haemodynamic therapy on postoperative outcome in non-cardiac surgery patients – a systematic review and meta-analysis

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Key result

Cardiac index-guided therapy cuts postoperative complications ~41% vs standard care in non-cardiac surgery.

OR 0.59
95% CI 0.45-0.78
n=3,204

Why the study?

While optimal perioperative haemodynamic management is essential to reduce postoperative complications, clear evidence on the effectiveness of cardiac index-guided goal-directed therapy (CI-GDT) compared to standard care in non-cardiac surgery was lacking.

Does perioperative cardiac index-guided goal-directed haemodynamic therapy reduce the incidence of postoperative complications and mortality compared with usual care in adults undergoing elective non-cardiac surgery?

Key Points

To investigate the impact of cardiac index-guided goal-directed therapy (CI-GDT) compared to standard care on postoperative outcomes in adult non-cardiac surgery patients.
Systematic review and meta-analysis of 21 randomized controlled trials (cumulative N=3204) comparing CI-GDT (n=1608) to standard care (n=1596) across adult non-cardiac surgical procedures, registered in PROSPERO (CRD420251058399).
Risk of bias was evaluated with the RoB 2 tool, and random-effects models were used to calculate odds ratios (OR) with 95% confidence intervals (CI) and 95% prediction intervals (PI).
In 20 RCTs, CI-GDT significantly reduced the incidence of experiencing at least one postoperative complication compared to control (OR 0.59 [95% CI 0.45–0.78]; 95% PI 0.20–1.74; I2 = 62.9%; n=672 events in CI-GDT vs. n=761 in control).
In 11 RCTs reporting mortality, overall postoperative mortality did not differ significantly between groups (OR 0.77 [95% CI 0.57–1.05]; 95% PI 0.47–1.25; I2 = 0%; 40 of 1205 deaths in CI-GDT vs. 56 of 1270 in control).
Publication bias assessments via funnel plot and Egger's test revealed no significant asymmetry (p=0.15), and the overall certainty of evidence was graded as high.

Study Design

Type

Meta-Analysis (n=3,204)

Structured PICO

Does perioperative cardiac index-guided goal-directed haemodynamic therapy reduce the incidence of postoperative complications and mortality compared with usual care in adults undergoing elective non-cardiac surgery?

P

Population

3,204 adult patients (≥18 years) across 21 RCTs undergoing elective non-cardiac surgery (predominantly abdominal/visceral, neuro-, vascular, orthopaedic, urologic, gynaecologic, head and neck, and thoracic surgery), excluding emergency and cardiac surgery.

I

Intervention

Perioperative Cardiac Index-guided goal-directed haemodynamic therapy (CI-GDT) incorporating an explicit CI target (16 studies used a fixed threshold of > or ≥2.5 L/min/m², 1 used ≥2.2 L/min/m², 2 combined preload-optimised CI with a minimum of 2.5 L/min/m², 1 targeted preoperative resting CI, and 1 used age-specific thresholds) alongside other variables (e.g., MAP, SVV, PPV, SV) to guide fluid administration, vasopressors, and inotropic support (predominantly dobutamine, as well as dopamine, ephedrine, or theodrenalin/cafedrin).

C

Comparator

Conventional or usual perioperative haemodynamic care (n=1,596).

O

Outcome

Number of participants experiencing at least one postoperative complication, based on trial-specific composite outcome definitions (ranging from 4 to 39 items, mostly cardiovascular, pulmonary, renal, infectious complications, and mortality) and trial-specific postoperative observation periods.composite

Main Result

Odds Ratio: 0.59 (95% CI 0.45–0.78)

Absolute Event Rate: 41.79% vs 47.68%

While perioperative cardiac index-guided goal-directed therapy reduces overall postoperative complications without affecting mortality in non-cardiac surgery, substantial heterogeneity and a prediction interval crossing the null preclude routine widespread implementation across all surgical settings.

Limitations

Substantial clinical and statistical heterogeneity across studies (I2 = 62.9%) with a wide 95% prediction interval (0.20-1.74) crossing the null
Definitions and observation periods for postoperative complications and mortality were not uniform across included trials
Literature search was restricted to PubMed and Web of Science and did not include Embase or CENTRAL
Included evidence was derived from multiple relatively small trials involving clinically heterogeneous patient populations and diverse surgical procedures
Because CI was embedded within multimodal haemodynamic algorithms alongside SV, SVV, PPV, and MAP targets, the isolated incremental effect of CI targeting cannot be determined
Substantial clinical and methodological heterogeneity across relatively small trials with diverse surgical procedures, monitoring devices, and multimodal treatment algorithms
Non-uniform definitions and observation periods for composite postoperative complications and mortality across included trials
Literature search restricted to PubMed and Web of Science without searching Embase or CENTRAL
Inability to isolate the incremental effect attributable specifically to CI targeting because CI was embedded within multimodal haemodynamic algorithms

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Reduces postoperative complications in non-cardiac surgery; extends prior evidence but heterogeneity and wide prediction interval leave routine adoption open.

Abstract

Background Optimal perioperative haemodynamic management is essential to reduce postoperative complications. While multiple technologies allow for advanced monitoring, clear evidence on the effectiveness of Cardiac Index-guided goal-directed therapy (CI-GDT) compared to standard care in non-cardiac surgery is lacking. This systematic review and meta-analysis aimed to investigate the impact of CI-GDT on postoperative outcome. Methods A systematic search using PubMed and Web of Science (2010–2025) identified randomised controlled trials (RCT) comparing CI-GDT to standard care in adult non-cardiac surgery. Study selection and data extraction were conducted according to PRISMA guidelines and registered under PROSPERO (CRD420251058399). Odds ratios (OR) with 95% confidence intervals (CI) and 95% prediction intervals (PI) were calculated using a random-effects model. Risk of bias was assessed via the RoB 2 tool. Heterogeneity was quantified with I 2 , τ 2 , and Cochran’s Q. Reporting bias was evaluated by funnel plots, Egger’s test, and trim-and-fill method. Sensitivity was assessed by leave-one-out analysis. Results Twenty-one RCTs were included, of which 20 contributed data to the meta-analysis of postoperative complications. CI-GDT significantly reduced the incidence of postoperative complications (OR .59 [.45–.78]; PI .20–1.74; I 2 = 62.9%). Mortality did not differ significantly between groups (OR 0.77 [.57–1.05]; I 2 = 0%). Funnel plot and Egger’s test indicated no significant publication bias ( p =.15). Leave-one-out analysis confirmed robustness of findings. Trim-and-fill did not suggest missing studies. Certainty of evidence was graded high. Discussion/conclusion CI-GDT was associated with a lower incidence of patients experiencing at least one postoperative complication, whereas mortality did not differ significantly. However, substantial heterogeneity and a prediction interval crossing the null indicate that the benefit may not be consistent across clinical settings. These findings do not establish an independent advantage of CI targeting over other GDT strategies.

Discussion

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Cite This Study

Omuro et al. (2026) conducted a meta-analysis in Adult patients undergoing elective non-cardiac surgery (n=3,204). Cardiac Index-guided goal-directed therapy (CI-GDT) vs. Standard or usual perioperative haemodynamic care was evaluated on Incidence of patients experiencing at least one postoperative complication (composite outcome) (OR 0.59, 95% CI 0.45-0.78). Cardiac index-guided goal-directed therapy significantly reduced postoperative complications compared to standard care in non-cardiac surgery (OR 0.59, 95% CI 0.45-0.78; I²=62.9%).

synapsesocial.com/papers/6aefbd4950d2071ffda4bc63 https://doi.org/10.1186/s13741-026-00760-8

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Effect of cardiac-index guided intraoperative haemodynamic therapy on postoperative outcome in non-cardiac surgery patients – a systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Effect of cardiac-index guided intraoperative haemodynamic therapy on postoperative outcome in non-cardiac surgery patients – a systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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