Implementation of goal-directed fluid therapy during hip revision arthroplasty: a matched cohort study

Marit Habicher, Felix Balzer, Viktor Mezger, Jennifer Niclas, Michael Müller, Carsten Perka, Michael Krämer, Michael Sander

Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. However, very few studies have demonstrated the value of goal-directed therapy (GDT) in patients undergoing orthopaedic surgery and confirmed it is as useful in real-life conditions. Therefore, we initiated a GDFT implementation programme in patients undergoing hip revision arthroplasty in order to assess its effects on postoperative complications (e.g. infection, cardiac, neurological, renal) (primary outcome) and hospital and intensive care unit (ICU) length of stay (secondary outcomes). We developed a GDFT protocol for the haemodynamic management of patients undergoing hip revision arthroplasty. The GDFT protocol was based on continuous monitoring and optimization of stroke volume during the surgical procedure. From December 2012 and for a period of 17 months, 130 patients were treated according to the GDFT protocol (GDFT group). The pre-, intra-, and postoperative characteristics of patients from the GDFT group were compared to those of 130 historical matched patients (control group) who had the same surgery between January 2011 and August 2012. Patients from the GDFT and from the control group were comparable in terms of age, comorbidities, and P-POSSUM score. Duration of anaesthesia and surgery were also comparable. The GDFT group had a significantly lower morbidity rate (49.2 vs. 66.9%; p = 0.006) and a shorter median hospital length of stay (11 days (9-15) vs. 9 days (8-12); p = 0.003) than the control group. Patients from the control group post-anaesthesia care unit (PACU)/ICU stayed significantly longer at PACU/ICU than patients from the GDFT group (control group vs. GDFT group, 960 min (360-1210) vs. 400 min (207-825); p < 0.001) Patients from the GDFT group received less crystalloids but more colloids during surgery. They also received more often inotropic therapy. In patients undergoing hip revision arthroplasty, the implementation of GDT as a new standard operating procedure was successful and associated with reduced postsurgical complications, most importantly a reduction in postoperative bleeding as well as hospital and ICU stay. ClinicalTrials.gov, NCT01753050.