Effects Of Intraoperative Goal-directed Fluid Therapy Based On Stroke Volume Variation On The Outcome Of Patients Undergoing Elective Open Liver Resection

Background: The mortality rate of liver surgery is far less than 5% nowadays, which makes it to be a safe procedure. Its postoperative morbidity rates, however, is still substantial. As a consequence the hospitalization after surgery is prolonged in those condition. Goal-directed fluid therpy(GDT) has been previously shown to improve postoperative outcome in various surgical procedures. But the beneficial evidence of GDT is limit on open liver resection which is usually associated with prolonged postoperative hospitalization.Objective : The aim of this prospective, randomized controlled study was to investigate whether intraoperative GDT improves the postoperative outcome in patients undergoing elective open liver resection.Method: Between August 2014 and May 2015, 70 consecutive patients scheduled for open liver resection were randomly assigned to GDT(n=35) or control group(n=35).Fluid management in GDT group was guided by stroke volume variation(SVV)measured by Vigileo/Flo Trac system, while conventional fluid management was used in control group. Primary outcome was length of hospital stay(LOHS). Intraoperative SVV and fluid volume, perioperative acid-base status and lactate concentration,postoperative hepatic and renal function, quality of recovery(Qo R) and complications were also analyzed.Result: There were no differences at baseline between the two groups. The median LOHS was significantly shortened in GDT group(11 days vs. 14 days in control group; P=0.040). Patients in GDT group received more colloid(1056±314 ml vs.806±263 ml in control group; P=0.001) and less crystalloid(961±304 ml vs.1152±347 ml in control group; P=0.018), but there was no difference in overall intraoperative fluid volume(2300±719 ml vs. 2186±505 ml in control group;P=0.454). Lower lactate concentration both at the end of surgery(2.16±0.77 mmol/l vs. 2.65±1.07 mmol/l in control group; P=0.034) and 8 h after surgery(2.29±0.33mmol/l vs. 2.57±0.45 mmol/l in control group; P=0.005), lower SVV(7.1±1.5% vs.9.3±2.6% in control group; P<0.001) and higher CI(3.7±0.5 L/min/m2 vs. 3.4±0.6L/min/m2 in control group; P=0.013) at the end of surgery, higher Qo R score on postoperative day 3(16(16-17) vs. 16(14.5-16) in control group; P=0.026) and day 4(17(17-18) vs. 17(16-18) in control group; P=0.045), as well as reduced all-caused complications(7(20%) vs. 15(45.5%) in control group; P=0.025, relative risk=0.440)in GDT group were observed. There were no differences on perioperative acid-base status and postoperative hepatic and renal function between the two groups.Conclusion: Intraoperative individualized GDT strategy improves the postoperative outcome in patients undergoing elective open liver resection. It is associated with shorter length of hospital stay, more stable hemodynamic status, more optimal tissue perfusion status, and lower incidence of postoperative complications.