The effect of compliance with a perioperative goal-directed therapy protocol on outcomes after high-risk surgery: a before-after study

M. F. Boekel, C. S. Venema, T. Kaufmann, I. C. C. van der Horst, J. J. Vos*, T. W. L. Scheeren

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)

Abstract

Perioperative goal-directed therapy is considered to improve patient outcomes after high-risk surgery. The association of compliance with perioperative goal-directed therapy protocols and postoperative outcomes is unclear. The purpose of this study is to determine the effect of protocol compliance on postoperative outcomes following high-risk surgery, after implementation of a perioperative goal-directed therapy protocol. Through a before-after study design, patients undergoing elective high-risk surgery before (before-group) and after implementation of a perioperative goal-directed therapy protocol (after-group) were included. Perioperative goal-directed therapy in the after-group consisted of optimized stroke volume variation or stroke volume index and optimized cardiac index. Additionally, the association of protocol compliance with postoperative complications when using perioperative goal-directed therapy was assessed. High protocol compliance was defined as >= 85% of the procedure time spent within the individual targets. The difference in complications during the first 30 postoperative days before and after implementation of the protocol was assessed. In the before-group, 214 patients were included and 193 patients in the after-group. The number of complications was higher in the before-group compared to the after-group (n = 414 vs. 282; p = 0.031). In the after-group, patients with high protocol compliance for stroke volume variation or stroke volume index had less complications compared to patients with low protocol compliance for stroke volume variation or stroke volume index (n = 187 vs. 90; p = 0.01). Protocol compliance by the attending clinicians is essential and should be monitored to facilitate an improvement in postoperative outcomes desired by the implementation of perioperative goal-directed therapy protocols.

Original languageEnglish
Pages (from-to)1193-1202
Number of pages10
JournalJournal of Clinical Monitoring and Computing
Volume35
Issue number5
Early online date12 Sep 2020
DOIs
Publication statusPublished - Oct 2021

Keywords

  • Perioperative goal-directed therapy
  • High-risk surgery
  • Before-after study
  • Protocol compliance
  • ENHANCED RECOVERY
  • FLUID THERAPY
  • GASTROINTESTINAL SURGERY
  • IMPACT
  • GUIDELINES
  • MANAGEMENT
  • SYSTEM
  • TRIAL

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