Is goal-directed fluid therapy beneficial for gastrointestinal surgery within an enhanced recovery program? A systematic review and meta-analysis

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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