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Perioperative Medicine

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Open Access 01-12-2018 | Research

Clinical and economic impact of goal-directed fluid therapy during elective gastrointestinal surgery

Authors: Juying Jin, Su Min, Dan Liu, Ling Liu, Bixiao Lv

Published in: Perioperative Medicine | Issue 1/2018

Abstract

Background

Several randomized controlled trials suggest that goal-directed fluid therapy (GDFT) may result in improved postoperative outcomes. The aim of this study was to assess the clinical and financial impact of the real-life implementation of intraoperative GDFT in patients undergoing elective gastrointestinal surgery in a Chinese tertiary medical center.

Methods

This Quality Improvement Program (QIP) study comprised three phases of 5, 1, and 5 months, respectively. During the first phase, we retrospectively collected perioperative data from patients who received standard intraoperative fluid management from January to May 2016. Then a 1-month training period allowed the clinical staff to become familiar with the GDFT protocol. After the training phase, GDFT was used from July to November 2016. In the GDFT group, stroke volume (SV) was continuously monitored and optimized towards the plateau of the Frank-Starling curve. The primary outcome measure was postoperative morbidity (the proportion of patients with one or more complications within 30 days after surgery). Secondary outcomes were total hospital cost, postoperative length of hospital stay, and 30-day mortality.

Results

Data from 200 patients before (control group) and 201 patients after the implementation of GDFT (GDFT group) were collected and compared. There was no significant difference in demographics and surgical procedures between the two groups. Postoperative morbidity was significantly lower in the GDFT group than in the control group (30.8% vs. 44.0%, p = 0.006). No significant differences were observed for mean total hospital cost (76,793 RMB vs. 74,444 RMB; p = 0.430), median postoperative length of hospital stay (10 days vs. 10 days; p = 0.104), and 30-day mortality (1% vs. 0.5%; p = 0.565).

Conclusion

In patients undergoing gastrointestinal surgery, the implementation of a GDFT protocol was associated with a reduction in postoperative morbidity without increasing costs.

Trial registration

clinicaltrials.gov, NCT02507557. Registered 13 July 2015.

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Title: Clinical and economic impact of goal-directed fluid therapy during elective gastrointestinal surgery
Authors: Juying Jin
Su Min
Dan Liu
Ling Liu
Bixiao Lv
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Perioperative Medicine / Issue 1/2018
Electronic ISSN: 2047-0525
DOI: https://doi.org/10.1186/s13741-018-0102-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical and economic impact of goal-directed fluid therapy during elective gastrointestinal surgery

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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