Is goal-directed ﬂuid therapy beneﬁcial for gastrointestinal surgery within an enhanced recovery program? A systematic review and meta-analysis
1Yabei Huang, Department of Anesthesiology, Yongchuan Aﬃliated Hospital of Chongqing Medical University, 402160 Chongqing, P. R. China
2Kaiyu Yin, Department of Anesthesiology, West China Women’s and Children’s Hospital, Sichuan, P. R. China
3Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education 610066 P. R. China
4Xinpei Zhang, Department of Anesthesiology, Yongchuan Aﬃliated Hospital of Chongqing Medical University, 402160 Chongqing, P. R. China
5Mingqing Peng, MD, Professor, Department of Anesthesiology, Yongchuan Aﬃliated Hospital of Chongqing Medical University, 402160 Chongqing, P. R. China
DOI: 10.22514/sv.2020.16.0099 Vol.17,Issue 3,May 2021 pp.225-233
Submitted: 03 October 2020 Accepted: 30 October 2020
Published: 08 May 2021
Objectives: To systematically evaluate the clinical effect of intraoperative goal-directed fluid therapy (GDFT) in gastrointestinal surgery within an enhanced recovery after surgery (ERAS) program.
Methods: EMBASE, MEDLINE, Cochrane Library, PubMed, OVID, CNKI and other databases were searched for randomized controlled trials (RCTs) from the inception dates to December 2018. These studies included patients undergoing elective gastrointestinal surgery comparing regular fluid therapy versus GDFT within ERAS. The meta-analysis was carried on with RevMan 5.3.
Results: A total of 10 RCT studies were included with 1216 patients. Compared with the regular fluid therapy group, the GDFT group reduced the rate of readmission [odds ratio, OR = 1.67, 95% CI (1.05, 2.65), P = 0.03] in gastrointestinal surgery patients within ERAS. However, there was no significant decrease in length of hospital stay (LOHS) [mean difference, MD = -0.11, 95% CI (-1.22, 1.00), P = 0.85], postoperative morbidity [OR = 0.78, 95% CI (0.55, 1.11), P = 0.17], postoperative mortality [OR = 0.86, 95% CI (0.30, 2.49), P = 0.78], postoperative ileus [OR = 1.24, 95% CI (0.70, 2.19), P = 0.45], anastomotic leaks [OR= 0.66, 95% CI (0.29, 1.49), P = 0.31] and the first gastrointestinal motility time [MD = -0.37, 95% CI (-1.07, 0.33), P = 0.30].
Conclusions: The current evidence demonstrates that, in gastrointestinal surgery within ERAS, GDFT decreased the rate of readmission. However, there was no advantage over regular fluid therapy in the reduction of LOHS, postoperative morbidity, postoperative mortality, postoperative ileus and anastomotic leaks.
Enhanced recovery after surgery; Goal-directed fluid therapy; Gastrointestinal surgery; Meta-analysis; Randomized controlled trial
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