Goal-directed Haemodynamic Therapy During General Anaesthesia for Noncardiac Surgery: a Systematic Review and Meta-analysis

Overview

Journal Br J Anaesth

Publisher Elsevier

Specialty Anesthesiology

Date 2021 Dec 17

PMID 34916049

Citations 34

Authors

Marie K Jessen

Mikael F Vallentin

Mathias J Holmberg

Maria Bolther

Frederik B Hansen

Johanne M Holst

Andreas Magnussen

Niklas S Hansen

Cecilie M Johannsen

Johannes Enevoldsen

Thomas H Jensen

Lara L Roessler

Peter C Lind

Maibritt P Klitholm

Mark A Eggertsen

Philip Caap

Caroline Boye

Karol M Dabrowski

Lasse Vormfenne

Maria Hoybye

Jeppe Henriksen

Carl M Karlsson

Ida R Balleby

Marie S Rasmussen

Kim Paelestik

Asger Granfeldt

Lars W Andersen

Affiliations

Soon will be listed here.

Abstract

Background: During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes.

Methods: Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

Results: The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=-0.72 days; 95% CI, -1.10 to -0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence.

Conclusions: Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.

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