Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy

• Published in: British journal of surgery 2013-01, Vol.100 (1), p.66-74
• Main Authors: Srinivasa, S., Taylor, M. H. G., Singh, P. P., Yu, T.-C., Soop, M., Hill, A. G.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Colectomy - methods; Double-Blind Method; Elective Surgical Procedures - methods; Female; Fluid Therapy - methods; General aspects; Gluconates - therapeutic use; Humans; Laparoscopy; Length of Stay; Magnesium Chloride - therapeutic use; Male; Medical sciences; Potassium Chloride - therapeutic use; Prospective Studies; Sodium Acetate - therapeutic use; Sodium Chloride - therapeutic use; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.8940

Background: Goal‐directed fluid therapy (GDFT) has been compared with liberal fluid administration in non‐optimized perioperative settings. It is not known whether GDFT is of value within an enhanced recovery protocol incorporating fluid restriction. This study evaluated GDFT under these circumstances in patients undergoing elective colectomy. Methods: Patients undergoing elective laparoscopic or open colectomy within an established enhanced recovery protocol (including fluid restriction) were randomized to GDFT or no GDFT. Bowel preparation was permitted for left colonic operations at the surgeon's discretion. Exclusion criteria included rectal tumours and stoma formation. The primary outcome was a patient‐reported surgical recovery score (SRS). Secondary endpoints included clinical outcomes and physiological measures of recovery. Results: Eighty‐five patients were randomized, and there were 37 patients in each group for analysis. Nine patients in the GDFT and four in the fluid restriction group received oral bowel preparation for either anterior resection (12) or subtotal colectomy (1). Patients in the GDFT group received more colloid during surgery (mean 591 versus 297 ml; P = 0·012) and had superior cardiac indices (mean corrected flow time 374 versus 355 ms; P = 0·018). However, no differences were observed between the GDFT and fluid restriction groups with regard to surgical recovery (mean SRS after 7 days 47 versus 46 respectively; P = 0·853), other secondary outcomes (mean aldosterone/renin ratio 9 versus 8; P = 0·898), total postoperative fluid (median 3750 versus 2400 ml; P = 0·604), length of hospital stay (median 6 versus 5 days; P = 0·570) or number of patients with complications (26 versus 27; P = 1·000). Conclusion: GDFT did not provide clinical benefit in patients undergoing elective colectomy within a protocol incorporating fluid restriction. Registration number: NCT00911391 (http://www.clinicaltrials.gov). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. No value within a restrictive protocol