Intraoperative GDHT fails to improve postoperative outcomes in patients undergoing open radical cystectomy

A recent study investigated the effect of intraoperative GDHT on postoperative complications in patients who underwent open radical cystectomy. Intra-operative GDHT fails to improve postoperative outcomes in these patients, says Dr Hyun-Kyu Yoon and colleagues in their study published in BMC Anesthesiology.

In this prospective, single-centre, randomized controlled trial, 82 patients were scheduled for open radical cystectomy. Thirty-nine patients in the GDHT group received the stroke volume index- and cardiac index-based hemodynamic management using advanced hemodynamic monitoring. In the control group, 36 patients received the standard care under the discretion of attending anesthesiologists during surgery. Researchers measured the incidence of a composite of in-hospital postoperative complications during hospital stays as the primary outcome.

Key findings of this study are:

• The final analysis had 75 patients.
• They reported no significant difference in in-hospital postoperative complications incidence (71.8% vs. 83.3% with a risk difference of -0.12 between the groups.
• There were similarities in the amounts of intraoperative fluid administered between the groups (2700 vs. 2900 ml), with a median difference of -200.
• Two groups had comparable secondary outcomes. This included the incidence of seven major postoperative complications, duration of hospital and ICU and grade of complications.
• There were no significant differences between the GDHT and control group pertaining to postoperative eGFR, serum creatinine, and C-reactive protein.

In our study, they said Intraoperative GDHT did not improve postoperative outcomes.

Previous research shows that high-risk patients may benefit more from GDHT than non-high-risk patients. Most patients had ASA physical status II; they said the benefit from GDHT for our patients may have been less than that for high-risk patients.

Limitations of the study include sample size calculation based on the total complication rate of 40%, retrospective nature, uncertainty regarding the accuracy of post-induction assessment, exclusion of patients with severe systemic diseases and limited generalizability.

Reference:

Yoon, HK., Hur, M., Kim, D.H. et al. The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial. BMC Anesthesiol 23, 339 (2023). https://doi.org/10.1186/s12871-023-02285-9