PLoS ONE (Jan 2017)

Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study.

  • Denise P Veelo,
  • Mark I van Berge Henegouwen,
  • Kirsten S Ouwehand,
  • Bart F Geerts,
  • Maarten C J Anderegg,
  • Susan van Dieren,
  • Benedikt Preckel,
  • Jan M Binnekade,
  • Suzanne S Gisbertz,
  • Markus W Hollmann

DOI
https://doi.org/10.1371/journal.pone.0172806
Journal volume & issue
Vol. 12, no. 3
p. e0172806

Abstract

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BACKGROUND:Goal-directed therapy (GDT) can reduce postoperative complications in high-risk surgery patients. It is uncertain whether GDT has the same benefits in patients undergoing esophageal surgery. Goal of this Quality Improvement study was to evaluate the effects of a stroke volume guided GDT on post-operative outcome. METHODS AND FINDINGS:We compared the postoperative outcome of patients undergoing esophagectomy before (99 patients) and after (100 patients) implementation of GDT. There was no difference in the proportion of patients with a complication (56% vs. 54%, p = 0.82), hospital stay and mortality. The incidence of prolonged ICU stay (>48 hours) was reduced (28% vs. 12, p = .005) in patients treated with GDT. Secondary analysis of complication rate showed a decrease in pneumonia (29 vs. 15%, p = .02), mediastinal abscesses (12 vs. 3%, p = .02), and gastric tube necrosis (5% vs. 0%, p = .03) in patients treated with GDT. Patients in the GDT group received significantly less fluids but received more colloids. CONCLUSIONS:The implementation of GDT during esophagectomy was not associated with reductions in overall morbidity, mortality and hospital length of stay. However, we observed a decrease in pneumonia, mediastinal abscesses, gastric tube necrosis, and ICU length of stay.