Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement studyReport as inadecuate




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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.



Author: Denise P. Veelo, Mark I. van Berge Henegouwen, Kirsten S. Ouwehand, Bart F. Geerts , Maarten C. J. Anderegg, Susan van Dieren, Be

Source: http://plos.srce.hr/



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