Journal of Surgery and Trauma
نشریه جراحی و تروما
J Surg Trauma
Medical Sciences
http://jsurgery.bums.ac.ir
1
admin
2345-4873
2345-4873
en
jalali
1398
9
1
gregorian
2019
12
1
7
4
online
1
fulltext
en
Is perioperative goal-directed therapy able to reduce surgical complications in different surgical settings? A meta-analytic study
جراحی عمومی
General Surgery
متاآنالیز
Meta-analysis
<div style="text-align: justify;"></div>
<ul>
<li style="text-align: justify;"><strong>Introduction:</strong> Goal directed therapy (GDT) is a method aiming at optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications in high-risk patients, and a recent trial suggests its significant effect also in low-moderate risk patients. The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications, in both high and low-risk patients. Moreover, we stratified the effect of GDT in different kind of surgical procedures.</li>
<li style="text-align: justify;"><strong>Methods:</strong> Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with a least one postoperative complication. A subgroup analysis was also performed including RCTs with a mortality rate in the control group <10%, and considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery, and so on. Meta-analytic techniques (analysis software Rev Man, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs).</li>
<li style="text-align: justify;"><strong>Results:</strong> In 47 RCTs, 2329 patients developed at least one complication: 1030 out of 2781 (37%) were randomized to perioperative GDT, and 1299 out of 2772 (47%) were randomized to control. Pooled OR was 0.58 and 95% CI was 0.47-0.70. The sensitivity analysis confirmed the main result. The subgroup analysis including only studies in which the mortality rate in the control group was higher than 10% showed significant results (OR 0.51, 95% CI 0.35-0.74, p=0.004, 10 RCTs), as well as a statistical significant effect, was observed in those RCTs with a mortality rate in control group <10% (OR 0.59, 95% CI 0.47-0.74, p<0.0001, 37 RCTs). The subgroup analysis enrolling major abdominal patients showed a significant result (OR 0.69, 95% CI 0.57-0.83,p <0.0001, 29 RCTs, 3881 patients) as well as a significant effect was observed in those RCTs enrolling exclusively orthopedic (OR 0.48, 95% CI 0.30-0.79,p=0.004, 6 RCTs, 501 patients) and neurosurgical procedures (OR 0.40, 95% CI 0.21-0.78, p=0.008, 2 RCTs, 208 patients).</li>
<li style="text-align: justify;"><strong>Conclusions:</strong> The present meta-analysis suggests that GDT can reduce postoperative complication rates in high-risk as well as in low-risk patients. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic, and neurosurgical procedures. However, heterogeneity was found in some subgroups, reducing the strength of the results. Several well-designed RCTs are needed to further explore the effect of GDT in low-risk patients and in different kinds of surgeries.</li>
</ul>
Cardiac Output, Fluid Therapy, Meta-Analysis, Postoperative Complications
116
134
http://jsurgery.bums.ac.ir/browse.php?a_code=A-10-219-1&slc_lang=en&sid=1
Mariateresa
Giglio
mariateresagiglio@gmail.com
10031947532846007010
10031947532846007010
Yes
Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy
Giandomenico
Biancofiore
g.biancofiore@med.unipi.it
10031947532846007011
10031947532846007011
No
UO Anestesiae Rianimazione Trapianti, Università Degli Studi, Pisa
Filomena
Puntillo
filomena.puntillo@uniba.it
10031947532846007012
10031947532846007012
No
Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy
Stefano
Romagnoli
stefano.romagnoli@unifi.it
10031947532846007013
10031947532846007013
No
Dipartimento di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Careggi, Firenze
Luigi
Tritapepe
Luigi.Tritapepe@uniroma1.it
10031947532846007014
10031947532846007014
No
Direttore UOC Anestesia e Rianimazione, AO San Camillo Forlanini-Roma
Nicola
Brienza
nicola.brienza@uniba.it
10031947532846007015
10031947532846007015
No
Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy