The effect of compliance with a perioperative goal-directed therapy protocol on outcomes after high-risk surgery: a befo
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ORIGINAL RESEARCH
The effect of compliance with a perioperative goal-directed therapy protocol on outcomes after high-risk surgery: a before-after study M. F. Boekel1 · C. S. Venema1 · T. Kaufmann1 · I. C. C. van der Horst2 · J. J. Vos1 · T. W. L. Scheeren1 Received: 4 May 2020 / Accepted: 21 August 2020 © The Author(s) 2020
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. Keywords Perioperative goal-directed therapy · High-risk surgery · Before-after study · Protocol compliance
1 Introduction Perioperative goal-directed therapy (pGDT) aims to optimize the patient`s hemodynamic status using interventions to reach predefined target values in the perioperative period [1]. These interventions include administering fluids, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-020-00585-w) contains supplementary material, which is available to authorized users. * J. J. Vos [email protected] 1
Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700RB Groningen, The Netherlands
Chair of Department of Intensive Care, Maastricht University Medical Center+, Maastricht University, Maastricht, The Nether
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