Goal-directed fluid management reduces gastrointestinal complications after abdominal surgery: a meta-analysis

Aim: The present study aimed to determine whether goal-directed fluid management reduces incidence of post-surgery gastrointestinal complications and mortality in patients undergoing abdominal surgeries. Methods: Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, ISI, and Web of Science were searched for relevant randomized controlled trials. For qualitative data, relative risk (RR) was used to report effect sizes. For quantitative data, effect sizes were assessed using the mean difference. Results are presented as effect sizes and 95% confidence intervals (CI). Results: Incidence of gastrointestinal complications after goal-directed fluid management was lower than after standard fluid management (RR 0.48; 95% CI 0.33 to 0.69). Mortality rates at 30-day follow-ups were not significantly different between these two management methods. Concerning mortality rates within 60 days, goal-directed fluid management had a far lower mortality rate than standard fluid management (RR 0.32, 95% CI 0.11 to 0.93). Additionally, participants receiving goal-directed fluid management had significantly more volume of colloid solution than those with standard fluid management (MD 199.58, 95% CI 65.51 to 333.66, 10 studies). However, there were no significant differences in volume of crystalloid solution. Moreover, incidence of adverse events after goal-directed fluid management was significantly lower than after standard (routine) fluid management (RR 0.66; 95% CI 0.50 to 0.88). Conclusion: Goal-directed fluid management is an effective therapy for the reduction of GI complications and mortality within 60 days. Additionally, goal-directed fluid management can decrease incidence of postoperative adverse events.