Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery-a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Goal-directed hemodynamic therapy (GDHT) has been used in the clinical setting for years. However, the evidence for the beneficial effect of GDHT on postoperative recovery remains inconsistent. The aim of this systematic review and meta-analysis was to evaluate the effect of perioperative GDHT in comparison with conventional fluid therapy on postoperative recovery in adults undergoing major abdominal surgery.

Methods: Randomized controlled trials (RCTs) in which researchers evaluated the effect of perioperative use of GDHT on postoperative recovery in comparison with conventional fluid therapy following abdominal surgery in adults (i.e., >16 years) were considered. The effect sizes with 95% CIs were calculated.

Results: Forty-five eligible RCTs were included. Perioperative GDHT was associated with a significant reduction in short-term mortality (risk ratio [RR] 0.75, 95% CI 0.61-0.91, p = 0.004, I ² = 0), long-term mortality (RR 0.80, 95% CI 0.64-0.99, p = 0.04, I ² = 4%), and overall complication rates (RR 0.76, 95% CI 0.68-0.85, p < 0.0001, I ² = 38%). GDHT also facilitated gastrointestinal function recovery, as demonstrated by shortening the time to first flatus by 0.4 days (95% CI -0.72 to -0.08, p = 0.01, I ² = 74%) and the time to toleration of oral diet by 0.74 days (95% CI -1.44 to -0.03, p < 0.0001, I ² = 92%).

Conclusions: This systematic review of available evidence suggests that the use of perioperative GDHT may facilitate recovery in patients undergoing major abdominal surgery.

Keywords: Abdominal surgery; Gastrointestinal function; Goal-directed hemodynamic therapy; Morbidity; Mortality.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram of study selection. GDHT Goal-directed hemodynamic therapy, RCT Randomized controlled trial

Fig. 2

Review authors’ judgments about each risk of bias item presented as percentages across all included studies

Fig. 3

Meta-analysis and pooled risk ratio (RR) of the effect of perioperative goal-directed hemodynamic therapy (GDHT) on long-term mortality after major abdominal surgery and the influence analysis of individual studies on the pooled RR. Forest plots for (a) long-term mortality and (b) the influence of individual studies on the pooled RR

Fig. 4

Meta-analysis and pooled risk ratio (RR) of the effect of perioperative goal-directed hemodynamic therapy (GDHT) on short-term mortality after major abdominal surgery and the influence analysis of individual studies on the pooled RR. Forest plots for (a) short-term mortality and (b) the influence of individual studies on the pooled RR

Fig. 5

Meta-analysis and pooled risk ratio (RR) of the effect of perioperative goal-directed hemodynamic therapy (GDHT) on overall complication rates after major abdominal surgery and the influence analysis of individual studies on the pooled RR. Forest plots for (a) overall complication rates and (b) the influence of individual studies on the pooled RR

Fig. 6

Meta-analysis and pooled weighted mean differences (WMDs) of the effect of perioperative goal-directed hemodynamic therapy (GDHT) on (a) time to first flatus pass, (b) time to first bowel movement, and (c) time to toleration of an oral diet after major abdominal surgery and the influence analysis of individual studies on the WMD. Left side shows Forest plots, and right side shows the influence of individual studies on the pooled estimates