Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery

TLDR

Intraoperative hypovolemia is common and can lead to organ dysfunction, increased morbidity, longer hospital stays, and death. This prospective randomized study evaluated whether goal‑directed intraoperative fluid therapy reduces postoperative hospital length of stay. One hundred major‑surgery patients with >500 ml expected blood loss were randomized to standard care or to a protocol group receiving esophageal Doppler‑guided plasma volume expansion to maintain maximal stroke volume, with postoperative stay and morbidity recorded. The protocol group achieved higher stroke volume and cardiac output, returned to oral intake earlier, and had a significantly shorter hospital stay (5 ± 3 vs 7 ± 3 days) with lower nausea/vomiting incidence.

Abstract

Background Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. Methods One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. Results Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). Conclusions Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.