The Effect Of Goal-directed Fluid Therapy On Gastrointestinal Surgery Within An Enhanced Recovery Program:A Systematic Review And Meta-analysis

Objective To systematically compare the clinical efficacy and safety of intraoperative goal directed fluid therapy(GDFT)with regular fluid therapy in gastrointestinal surgery within an enhanced recovery program.Methods MEDLINE,EMBASE,The Cochrane Library?PubMed?OVID?CNKI databases were electronically searched to collect randomized controlled trials(RCTs)from inception to December 2018.These studies were related to adult patients undergoing elective gastrointestinal surgery comparing regular fluid therapy versus GDFT within an enhanced recovery program.According to the inclusion and exclusion criteria,two investigators independently screened the literature to extract information and assess the risk of bias.Statistical analysis was performed using RevMan 5.3 software by a third investigator.Results A total of 10 RCT studies met the inclusion criteria with1216 patients.The results of meta-analysis showed that: Compared with regular fluid therapy,goal directed fluid therapy reduced the rate ofreadmission(OR=1.67,95% CI 1.05 to 2.65,P=0.03)in gastrointestinal surgery within an enhanced recovery program.However,it had no relationship to reduction of Length of hospital stay(MD=-0.11,95%CI-1.22 to 1.00,P=0.85);the first bowl motion(MD=-0.37,95%CI-1.07 to0.33,P=0.30),postoperative morbidity(OR=0.78,95%CI 0.55 to 1.11,P=0.17),mortality(OR=0.86,95%CI 0.30 to 2.49,P=0.78),postoperative ileus(OR=1.24,95%CI 0.70 to 2.19,P=0.45),anastomotic leak OR=0.66,95%CI 0.29 to 1.49,P=0.31)and so on.There were not any statistical differences between them.Conclusion In gastrointestinal surgery within an enhanced recovery program,we found that GDFT only decreased the rate of readmission.It had no advantage over the traditional fluid therapy in the reduction of length of hospital stay,postoperative morbidity,mortality,postoperative ileus and anastomotic leak.Because of the heterogeneity and number of studies analyzed.More high-quality researches and large prospective trails would be useful to verify our findings of this study.