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

• Published in: PloS one Vol. 12; no. 3; p. e0172806
• Main Authors: Veelo, Denise P, van Berge Henegouwen, Mark I, Ouwehand, Kirsten S, Geerts, Bart F, Anderegg, Maarten C J, van Dieren, Susan, Preckel, Benedikt, Binnekade, Jan M, Gisbertz, Suzanne S, Hollmann, Markus W
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.03.2017; Public Library of Science (PLoS)
• Subjects: Abscesses; Aged; Anesthesia; Anesthesiology; Anti-Infective Agents - pharmacology; Cardiovascular disease; Clinical trials; Colloids; Colorectal surgery; Comparative analysis; Complications; Esophageal surgery; Esophagectomy - adverse effects; Esophagus; Esophagus - surgery; Female; Fluids; Gastrointestinal surgery; Goals; Guideline Adherence; Health aspects; Hemodynamics; Humans; Length of Stay; Male; Medicine and Health Sciences; Middle Aged; Morbidity; Mortality; Necrosis; Patient outcomes; Patients; Physical Sciences; Pneumonia; Postoperative Complications - therapy; Quality control; Quality Improvement; Risk factors; Secondary analysis; Stroke; Stroke volume; Studies; Surgery; Surgical outcomes; Teaching hospitals; Therapy; United States; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0172806

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. 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. 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.